单侧双通道与经皮椎间孔内镜下治疗腰椎间盘突出症的临床疗效比较

Comparison of clinical efficacy between unilateral biportal endoscopy and percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

目的比较单侧双通道内镜技术(unilateral biportal endoscopy,UBE)与经皮椎间孔脊柱内镜技术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症的临床疗效。方法回顾性分析2020年3月至2022年3月首都医科大学附属北京朝阳医院脊柱内镜治疗的腰椎间盘突出症患者87例,UBE组39例,PELD组48例。分别记录两组患者的年龄、性别、体质量指数(body mass index,BMI)、住院时间、手术时间、术中透视次数、出血量、手术前后血红蛋白的减少值、随访时间、术后并发症。术前、术后1个月、3个月及12个月随访时进行腰腿痛视觉模拟量表(Visual Analogue Scale,VAS)评分和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估。术后12个月应用改良MacNab标准评价临床疗效。比较两组患者术前、术后12个月硬膜囊面积变化。结果所有患者均顺利完成手术。两组患者的年龄、性别、BMI、住院时间、手术时间、随访时间、术后并发症差异无统计学意义(P>0.05)。UBE组术中出血量较PELD组多(P<0.05),但血红蛋白减少值差异无统计学意义(P>0.05)。UBE组术中透视次数少于PELD组(P<0.05)。两组患者术后1个月、3个月及12个月腰腿痛VAS评分和ODI较术前均明显下降(P<0.05),两组患者各时间点腰腿痛VAS评分及ODI差异均无统计学意义(P>0.05)。术后两组优良率差异无统计学意义(P>0.05)。两组患者术后12个月硬膜囊面积较术前均显著增大(P<0.05),UBE组较PELD组更为明显(P<0.05)。结论UBE与PELD治疗腰椎间盘突出症均可有效缓解疼痛,改善患者生活质量。UBE较PELD出血量略多,但术中透视次数少,硬膜囊面积的改善更优。

Objective To compare the clinical efficacy between unilateral biportal endoscopy(UBE)and percutaneous endoscopic lumbar discectomy(PELD)in the treatment of patients with lumbar disc herniation(LDH).Methods A total of 87 cases of LDH treated with spinal endoscopy from March 2020 to March 2022 were analyzed retrospectively,including 39 cases by UBE and 48 cases by PELD.The relevant data of the two groups of patients were recorded separately,including age,gender,body mass index(BMI),hospital stay,surgical time,intraoperative X-ray times,bleeding volume,preoperative and postoperative hemoglobin(Hb)reduction,follow-up time,postoperative complications.The Visual Analogue Scale(VAS)for low back pain and leg pain respectively,and Oswestry Disability Index(ODI)were evaluated before surgery,1 month,3 months and 12 months after operation.The modified MacNab criteria were used for evaluation of the clinical outcomes at 12 months after operation.The changes of dural sac area between two groups of patients before surgery and 12 months after surgery were compared.Results All patients successfully completed the surgery.There was no statistically significant difference in age,gender,BMI,hospital stay,surgical time,follow-up time,and postoperative complications between the two groups of patients(P>0.05).UBE group had more intraoperative bleeding compared to PELD group(P<0.05),but there was no statistically significant difference in Hb reduction(P>0.05).The times of intraoperative X-ray in the UBE group was lower than that in the PELD group(P<0.05).The VAS score of low back and leg pain and ODI in the two groups of patients at 1 month,3 months,and 12 months after surgery were significantly reduced compared to that before surgery(P<0.05).There was no statistical difference in VAS score of low back and leg pain and ODI at each time point between the two groups of patients(P>0.05).There was no statistically significant difference in the excellent and good rate of modified MacNab criteria between the two groups after surgery(P>0.05).The dural sac area of both groups significantly increased at 12 months after surgery compared to that before(P<0.05),and the area of UBE group was more bigger than that of PELD group(P<0.05).Conclusion UBE and PELD can effectively relieve pain and improve the quality of life of patients with LDH.UBE has slightly more bleeding volume than PELD,but has fewer intraoperative X-ray times and a bigger increase in dural sac area.