单侧双通道脊柱内镜髓核摘除术治疗腰椎间盘突出症

Unilateral biportal endoscopy discectomy for treatment of lumbar disc herniation

目的探讨单侧双通道脊柱内镜髓核摘除术治疗腰椎间盘突出症的疗效。方法采用单侧双通道脊柱内镜下髓核摘除术治疗37例腰椎间盘突出症患者。记录手术时间、切口长度、血红蛋白、SF-36生活质量评分、疼痛VAS评分、ODI,根据椎间盘高度指数(DHI)、矢状位椎体移动角度(sROM)评价椎体稳定性情况。结果患者均获得随访,时间6~15个月。手术时间90~115(105.00±16.32)min。切口长度:观察通道9~12(10.30±2.20)mm,工作通道11~14(12.10±1.20)mm。血红蛋白术后7 d与术前比较差异无统计学意义(P>0.05)。SF-36生活质量评分术后7 d较术前改善(P<0.05)。疼痛VAS评分术后1 d、1个月、3个月及末次随访均较术前降低(P<0.05);ODI术后1、3个月及末次随访均较术前降低(P<0.05);上述2项指标均随着时间推移逐渐降低(P<0.05)。DHI及sROM术后1个月、3个月、末次随访与术前比较差异均无统计学意义(P>0.05),术后各时间点比较差异均无统计学意义(P>0.05)。结论单侧双通道脊柱内镜髓核摘除术治疗腰椎间盘突出症能提供清晰的手术视野,操作空间充足,创伤小,能有效地缓解患者腰腿痛症状,对腰椎稳定性影响小。

Objective To investigate the therapeutic effect of unilateral biportal endoscopy discectomy in the treatment of lumbar disc herniation.Methods The 37 patients with lumbar disc herniation were treated with unilateral biportal endoscopy discectomy.Operation time,incision length,hemoglobin,SF-36 quality of life score,pain VAS and Oswestry disability index(ODI)were recorded.Vertebral stability was evaluated according to disc height index(DHI)and sagittal range of motion(sROM).Results All patients were followed up from 6 months to 15 months.The operation time was 90~115(105.00±16.32)min.The incision length was 9~12(10.30±2.20)mm in the observation channel and 11~14(12.10±1.20)mm in the working channel.There was no statistical difference in hemoglobin at 7 d after surgery,compared with the preoperation(P>0.05),and at 7 d postoperation,SF-36 quality of life score was improved than before surgery(P<0.05).The pain VAS:at 1 d,1,3 months postoperation and the last follow-up after surgery,they were all lower than that before surgery(P<0.05);compared with that before surgery,ODI was decreased at 1,3 months postoperation and the last follow-up(P<0.05);the above two indexes were decreased gradually with the passage of time(P<0.05).DHI and sROM had no statistical differences between preoperation and the postoperative 1,3 months,the last follow-up(P>0.05),and there were all no statistical differences at various time-point postoperatively(P>0.05).Conclusions Unilateral biportal endoscopy discectomy provide a clear surgical field,sufficient operating space,less trauma,and effectively relieve the symptoms of patients′low back pain and leg pain,and which has little effect on the stability of lumbar spine.