单侧双通道内镜技术治疗椎管内高度游离型腰椎间盘突出症

Clinical Outcomes of Unilateral Biportal Endoscopy for Intraspinal High-grade Migrated Lumbar Intervertebral Disc Herniation

目的探讨单侧双通道内镜技术(unilateral biportal endoscopy,UBE)治疗椎管内高度游离型腰椎间盘突出症的临床疗效。方法回顾性分析2020年3月至2021年9月福建医科大学附属漳州市医院脊柱骨科采用UBE技术治疗的22例椎管内高度游离型腰椎间盘突出症病人,记录术前、术后3个月、术后12个月的腰、腿疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI),末次随访时采用改良Mac Nab标准进行疗效评价。术后2天复查CT、术后3个月复查MRI及腰椎动力位X线片,观察腰椎稳定性及邻近节段退变情况。结果22例病人均顺利完成手术,手术时间为(135.3±2.0)min(120~180min),术后所有病人均获得随访,随访时间(16.5±2.0)个月(12~23个月)。术后3、12个月VAS评分、ODI均较术前明显改善,差异有统计学意义(P<0.05)。术后有2例出现硬脊膜破裂,经改变体位、延长拔管时间、预防感染等对症治疗后均痊愈;1例出现术后腰背部不适,予卧床休息、药物对症处理后症状缓解。末次随访时改良Mac Nab标准评价结果:优18例,良3例,可1例,优良率为95.45%,且无复发病例。术后复查CT、X线片及MRI示无腰椎不稳、邻近节段退变等情况发生。结论UBE治疗椎管内高度游离型腰椎间盘突出症早期临床疗效满意。

Objective To evaluate the clinical outcomes of unilateral biportal tendoscopy(UBE)for intraspinal high-grade migrated lumbar intervertebral disc herniation.Methods Totally,22 patients with intraspinal high-grade migrated lumbar intervertebral disc herniation treated by UBE in Zhangzhou Affiliated Hospital of Fujian Medical University from March 2020 to September 2021 were retrospectively analyzed.Visual analogue scale(VAS)of lumbar and leg pain and Oswestry disability index(ODI)were recorded before and 3 months,12 months after operation.The efficacy was evaluated by modified MacNab standard at the last follow-up.The stability and adjacent segment degeneration of the lumbar spine were observed by CT scan 2 days after surgery,MRI and lumbar dynamic radiograph at 3-month follow-up.Results All the 22 patients completed the operation successfully.The operation time was(135.3±2.0)min(120-180 min).All patients were followed up for(16.5±2.0)months(12-23)months.VAS and ODI scores were significantly improved at 3rd and 12th month after surgery(P<0.05).Two patients had dural rupture after surgery,and all recovered after the symptomatic treatment such as changing position,prolonging extubation time,and preventing infection.One patient experienced discomfort in the lower back during surgery,which was relieved after bed rest and symptomatic medication treatment.At the last follow-up,the modified MacNab criteria were used to evaluate clinical efficacy:excellent in 18 cases,good in 3 cases and fair in 1 case,with an excellent/good rate of 95.45%.No recurrence occurred in this group.Postoperative CT,X-ray and MRI showed no lumbar instability or adjacent segment degeneration.Conclusion UBE in the treatment of intraspinal high-grade migrated lumbar intervertebral disc herniation has satisfactory early clinical outcomes.