单侧双通道与经皮椎板间内镜治疗腰5骶1椎间盘突出症的短期临床疗效比较

Comparative study on short-term clinical efficacy of unilateral biportal and percutaneous interlaminar endoscopic in the treatment of L_(5)S_(1) disc herniation

目的比较单侧双通道内镜椎间盘切除术(unilateral biportal endoscopic discectomy,UBED)与经皮内镜椎板间入路椎间盘切除术(percutaneous endoscopic interlaminar discectomy,PEID)治疗腰5骶1(L_(5)S_(1))腰椎间盘突出(lumbar disc herniation,LDH)的短期临床疗效。方法2019年1月~2021年1月我院分别应用UBED或PEID治疗的L_(5)S_(1)LDH病人57例,其中UBED组30例,PEID组27例。比较两组病人手术时间、术中透视次数、术后住院时间和手术并发症,使用视觉模拟评分量表(VAS)和Oswestry功能障碍指数(ODI)比较两组病人术后生活质量,术后1.5年随访使用改良MacNab标准评价临床疗效。结果UBED组和PEID组手术时间分别为(75.30±8.44)分钟和(68.37±4.63)分钟,两组比较差异有统计学意义(P<0.05)。两组病人术后1周、术后3个月、术后1年及术后1.5年的VAS及ODI均较术前明显下降,差异有统计学意义(P<0.05),除术后1周UBED组腰痛VAS评分高于PEID组[(3.87±1.14)分vs(2.70±0.67)分](P<0.05),其余相同时间点的VAS及ODI比较,差异无统计学意义(P>0.05);术后1.5年随访改良MacNab评定标准结果比较,差异无统计学意义(P>0.05)。PEID组出现2例硬膜撕裂,UBED组出现1例硬膜撕裂,PEID组术后出现1例神经根短暂损伤,均对症治疗后痊愈。结论与PEID比较,UBED手术时间更长,创伤更大,术后短期内腰痛更明显,并发症发生率低,透视次数少。两种术式对L5S1LDH的近期疗效接近,均为安全有效的手术方式。

Objective To compare the short-term clinical effects of unilateral dual-channel endoscopic discectomy(UBED)and percutaneous endoscopic intervertebral discectomy(PEID)in the treatment of L_(5)S_(1)Lumbar disc herniation,LDH.Methods From January 2019 to January 2021,a total of 57 cases of L_(5)S_(1)LDH treated by UBED or PEID were analyzed retrospectively,including 30 cases in UBED group and 27 cases in PEID group.The operation time,intraoperative fluoroscopy times,postoperative hospitalization days and surgical complications were compared between the two groups.The visual analogue scale(VAS)and oswestry disability index(ODI)were used to compare the postoperative quality of life of the two groups,and the modified MacNab criteria was used to evaluate the clinical efficacy in the last follow-up.Results The operation time of UBED group and PEID group was(75.30±8.44)minutes and(68.37±4.63)minutes,respectively,and the difference between the two groups was statistically significant(P<0.05).VAS and ODI of 1 week,3 months,1 year and 1.5 years after surgery in 2 groups were significantly decreased compared with those before surgery,with statistical significance(P<0.05).The VAS score of low back pain in UBED group was higher than that in PEID group[(3.87±1.14)points vs(2.70±0.67)points]at 1 week after surgery(P<0.05),and there was no significant difference in VAS and ODI at the other time points(P>0.05).There was no statistical difference in the results of modified MacNab criteria in the last follow-up(P>0.05).There were 2 cases of dural tear in PEID group,1 case of dural tear in UBED group and 1 case of temporary nerve root injury in PEID group after operation,all of which were cured after symptomatic treatment.Conclusion Compared with PEID,UBED has a longer operation time,more trauma and more obvious low back pain in the short term after operation.The short-term curative effect of the two operations on L_(5)S_(1) LDH is similar,the incidence of complications is low,and the times of fluoroscopy are few.Both operations are safe and effective.