3种腰椎髓核摘除术治疗腰椎间盘突出症的疗效比较

Comparison effect of three kinds of discectomy for lumbar disc herniation

目的比较微创显微镜辅助椎间盘切除术(MSLD)、椎板间入路单通道内镜(IUE)和单侧双通道内镜(UBE)治疗腰椎间盘突出症的疗效。方法将70例腰椎间盘突出症患者按照腰椎髓核摘除术的不同分为MSLD组(采用MSLD行腰椎髓核摘除治疗,20例)、IUE组(采用IUE行腰椎髓核摘除治疗,27例)、UBE组(采用UBE行腰椎髓核摘除治疗,23例)。比较3组术中透视次数、手术时间、术后住院时间、并发症发生情况、疼痛VAS评分、ODI。结果患者均获得随访,时间12~24(16.74±3.43)个月。术中透视次数:MSLD组、IUE组、UBE组依次增加(P<0.05)。手术时间:MSLD组、IUE组均短于UBE组(P<0.05);MSLD组和IUE组比较差异无统计学意义(P>0.05)。术后住院时间:IUE组、UBE组均短于MSLD组(P<0.05);IUE组和UBE组比较差异无统计学意义(P>0.05)。术后3 d切口疼痛:MSLD组、UBE组、IUE组依次降低(P<0.05)。下肢疼痛VAS评分、ODI:3组术后均优于术前(P<0.05);术后各时间点3组比较差异均无统计学意义(P>0.05)。并发症发生率3组比较差异无统计学意义(P>0.05)。结论MSLD、IUE和UBE均能有效治疗腰椎间盘突出症。相较于MSLD,IUE和UBE均是较微创的术式,均可缩短术后住院时间、减轻患者术后早期的切口疼痛,可作为MSLD的替代方案。且IUE在术中透视次数、手术时间方面较UBE更具优势。

Objective To compare the efficacy of three kinds of discectomy for lumbar disc herniation:microsurgical lumbar discectomy(MSLD),interlaminar uniportal endoscopy(IUE),and unilateral biportal endoscopy(UBE).Methods The 70 patients with lumbar disc herniation were divided into three groups according to surgical methods:MSLD group(20 cases),IUE group(27 cases)and UBE group(23 cases).The intraoperative fluoroscopy frequency,operation time,postoperative hospital length of stay,complications occurrence,pain VAS and Oswestry disability index(ODI)were compared among the three groups.Results All patients were followed up for 12~24(16.74±3.43)months.Intraoperative fluoroscopy frequency:the MSLD group,IUE group and UBE group were increased sequentially(P<0.01).Surgical time:the MSLD and IUE groups were both shorter than the UBE group(P<0.05);there was no statistical difference between the MSLD group and IUE group(P>0.05).Postoperative hospitalization time:the IUE and UBE groups were shorter than the MSLD group(P<0.05);there was no statistical difference between the IUE group and UBE group(P>0.05).At 3 d postoperation,incision pain was decreased sequentially in the MSLD group,UBE group and IUE group(P<0.05).Lower limb pain VAS and ODI of three groups were all better than the preoperation(P<0.05);there was no statistical difference among the three groups at each postoperative time-point(P>0.05).There were no statistical differences in the incidence rate of complications among three groups(P>0.05).Conclusions MSLD,IUE and UBE can treat lumbar disc herniation effectively.Compared with MSLD,both IUE and UBE are more minimal invasive procedures,which can shorten the postoperative hospitalization time and reduce the early postoperative incision pain,and can be used as an alternative to MSLD.IUE has more advantages than UBE in terms of intraoperative fluoroscopy frequency and operation time.