单侧双通道内镜髓核摘除术联合纤维环缝合术治疗腰椎间盘突出症

Unilateral biportal endoscopy discectomy combined with annulus fibrosus suture for treatment of lumbar disc herniation

目的探讨单侧双通道内镜髓核摘除术(UBED)联合纤维环缝合术治疗腰椎间盘突出症(LDH)的疗效。方法根据手术方式不同将83例LDH患者分为对照组(采用单纯UBED治疗,41例)和观察组(采用UBED联合纤维环缝合术治疗,42例)。记录两组手术时间、术中出血量、住院时间、疼痛VAS评分、ODI、复发率及再手术情况,采用改良MacNab评分评价疗效。结果患者均获得随访,时间12~15个月。两组住院时间比较差异无统计学意义(P>0.05)。手术时间及术中出血量观察组长(多)于对照组(P<0.05)。两组疼痛VAS评分及ODI术后3 d、1个月、6个月、12个月均较术前降低(P<0.05),且术后随时间延长逐渐降低(P<0.05);术后1个月ODI观察组低于对照组(P<0.05),其余各时段两组疼痛VAS评分、ODI比较差异均无统计学意义(P>0.05)。两组疗效优良率比较差异无统计学意义(P<0.05)。两组复发率及再手术率比较差异均无统计学意义(P>0.05)。结论UBED联合纤维环缝合术治疗LDH可获得满意的临床效果,术后早期恢复更快,但存在手术时间延长、术中出血量增大的缺点。

Objective To investigate the efficacy of unilateral biportal endoscopy discectomy(UBED)combined with annulus fibrosus suture for treatement of lumbar disc herniation(LDH).Methods According to different surgical methods,83 patients with LDH were divided into control group(treated with UBED,41 cases)and observation group(treated with UBED combined with annulus fibrosus suture,42 cases).The surgical duration,intraoperative blood loss,length of hospital stay,pain visual analogue scale(VAS),Oswestry disability index(ODI),recurrence rate,and re-operation conditions were recorded in both groups.The modified MacNab score was used to evaluate the efficacy.Results All patients were followed up for 12~15 months.The difference in length of hospital stay had no difference between two groups(P>0.05).However,the observation group had a longer surgical duration and more intraoperative blood loss,compared with the control group(P<0.05).At 3 d,1,6,12 months postoperatively,the pain VAS and ODI of both groups were decreased,compared with the preoperation(P<0.05),and gradually decreased with the time prolonging(P<0.05).At the 1-month follow-up,ODI in the observation group was lower than the control group(P<0.05),while there were no statistical differences in pain VAS and ODI between the two groups at other time-period(P>0.05).The excellent-good rate did not show a statistical difference between the two groups(P<0.05),and there were no statistical differences in the recurrence rate and re-operation rate between the two groups(P>0.05).Conclusions The combination of UBED and annulus fibrosus suture for LDH can obtain satisfactory clinical outcomes,with faster recovery in the postoperative early period,while it has the disadvantages of the prolonging operative time and the increase of intraoperative bleeding.