单侧双通道内镜下椎间盘切除术与经皮内镜下经椎间孔入路椎间盘切除术治疗腰椎间盘突出症的临床疗效对比

Clinical efficacy comparison of unilateral biportal endoscopic discectomy versus percutaneous endoscopic transforaminal discectomy for lumbar disc herniation

中文关键词:  腰椎间盘突出症  单侧双通道内镜下椎间盘切除术  经皮内镜下经椎间孔入路椎间盘切除术

英文关键词:Lumbar disc herniation  Unilateral biportal endoscopic discectomy  Percutaneous endoscopic transforaminal discectomy

中文摘要:

  【摘要】 目的：比较单侧双通道内镜下椎间盘切除术（unilateral biportal endoscopic discectomy，UBED）与经皮内镜下经椎间孔入路椎间盘切除术（percutaneous endoscopic transforaminal discectomy，PETD）治疗单节段腰椎间盘突出症（lumbar disc herniation，LDH）的短期临床疗效。方法：回顾性分析2020年3月～2020年6月我院分别应用UBED（UBED组）和PETD（PETD组）治疗单节段LDH患者56例，UBED组29例，其中男17例，女12例，年龄59.6±10.5岁，随访时间13.5±2.7个月。PETD组27例，其中男14例，女13例，年龄60.3±12.3岁，随访时间13.8±2.9个月。两组患者的年龄、性别、BMI、随访时间等一般资料均无统计学差异（P＞0.05）。记录并比较两组患者手术时间、术中透视次数、出血量、手术前后血红蛋白值和术后并发症等。使用视觉模拟量表（visual analogue scale，VAS）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）评价两组患者术前、术后3天、术后3个月及术后1年的生活质量，术后1年通过改良MacNab标准评价疗效，比较两组间是否存在差异。结果：所有患者均顺利完成手术。UBED组患者术中出血量较PETD组多（49.6±15.6ml vs 25.3±9.7ml，P<0.05），术中透视次数少（3.35±0.81次 vs 7.71±1.73次，P<0.05）。两组手术时间、术后并发症无统计学差异（P>0.05）。两组患者术前、术后血红蛋白值和血红蛋白减少值均无统计学差异（P>0.05）。两组患者术后3天、术后3个月及术后1年腰腿痛VAS评分和ODI较术前均明显下降（P<0.05），两组患者各时间点腰腿痛VAS评分及ODI均无统计学差异（P>0.05）。术后两组优良率差异无统计学差异（89.7% vs 88.9%，P>0.05）。结论：UBED与PETD治疗LDH均安全有效，与PETD相比，UBED可获得相似的疼痛缓解，改善患者的生活质量。UBED术中出血较PETD增加，但手术前后血红蛋白变化相当，UBED可有效减少术中透视次数。

英文摘要:

  【Abstract】 Objectives: To compare the short-term clinical outcomes between unilateral biportal endoscopic discectomy(UBED) and percutaneous endoscopic transforaminal discectomy(PETD) in the treatment of patients with single-level lumbar disc herniation(LDH). Methods: A total of 56 patients with single-level LDH undergoing UBED or PETD in our hospital between March 2020 to June 2020 were retrospectively analyzed. The patients were divided into UBED group of 29 cases including 17 males and 12 females(averaged 59.6±10.5 years and 13.5±2.7 months of follow-up) and PETD group of 27 cases including 14 males and 13 females (averaged 60.3±12.3 years and 13.8±2.9 months of follow-up). There were no significant differences in the general data such as age, gender, BMI, and follow-up period between the two groups(P＞0.05). The operative time, number of intraoperative fluoroscopy, blood loss, hemoglobin values, and postoperative complications of the two groups were recorded and compared. The quality of life before operation, 3 days, 3 months and 1 year after operation were evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). The curative effect was evaluated between the groups by modified MacNab criteria at 1 year after operation. Results: All the patients completed the procedure uneventfully. Comparing with the PETD group, patients in the UBED group had more intraoperative blood loss(25.3±9.7ml vs 49.6±15.6ml, P<0.05) and fewer times of intraoperative fluoroscopy(7.71±1.73 vs 3.35±0.81, P<0.05). There was no significant difference in operative time or postoperative complications between the two groups(P>0.05), nor were there significant differences between the two groups in preoperative and postoperative hemoglobin values or in postoperative hemoglobin reductions(P>0.05). The VAS scores of low back and leg pain and ODI after surgery in both groups were significantly decreased compared with those before surgery(P<0.05), while there was no significant difference in the VAS of low back and leg pain and ODI between the two groups at each time point(P>0.05). The excellent/good rate of modified MacNab criteria at one year after operation was 89.7%(26/29) in the UBED group and 88.9%(24/27) in the PETD group(P=1.000). Conclusions: UBED and PETD were both safe and effective in the treatment of lumbar disc herniation. Comparing with PETD, UBED could achieve similar pain relief and improves patients′ quality of life. Although UBED increased intraoperative bleeding, changes in hemoglobin before and after surgery were comparable in both groups, and UBED was effective in reducing the number of intraoperative fluoroscopies.