单通道软质内镜系统辅助下髓核摘除治疗腰椎间盘突出症的临床疗效

Clinical efficacy of L-unitary soft endoscopy(LUSE) system assisted discectomy for lumbar disc herniation

中文关键词:  单通道软质内镜  腰椎间盘突出症  椎间盘髓核摘除  脊柱微创技术

英文关键词:Unitary soft endoscopy  Lumbar disc herniation  Nucleus pulposus removal  Minimally invasive spinal techniques

中文摘要:

  【摘要】 目的：探讨我团队自主研发的单通道软质内镜系统（L-unitary soft endoscopy，LUSE）辅助下椎间盘髓核摘除治疗腰椎间盘突出症中的应用效果，评估其临床疗效。方法：回顾性分析2024年6月～10月我院收治的行LUSE系统（LUSE组）或显微内镜辅助下髓核摘除术（microendoscopic discectomy，MED）（MED组）的腰椎间盘突出症患者资料。共纳入63例患者，其中LUSE组30例，男性17例，女性13例，年龄41.83±12.50岁；MED组33例，男性22例，女性11例，年龄45.79±14.25岁。比较两组患者的手术时间、术中出血量、手术切口长度、术后住院时间、并发症发生率等围手术期指标，并采用视觉模拟评分（visual analog scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评估术后腰腿痛改善情况及功能恢复；同时应用改良MacNab标准评估6个月随访时的总体临床疗效。结果：两组手术均顺利完成，术中及随访期无严重并发症。LUSE组在手术时间（55.17±10.77min vs 64.30±12.26min，P=0.003）、手术切口长度（中位数1.6cm vs 2.1cm，P<0.001）、术中出血量（中位数20mL vs 30mL，P=0.018）及术后住院时间（中位数4d vs 5d，P=0.008）方面均优于MED组。在临床疗效方面，两组患者术后的VAS与ODI评分较术前均显著改善（P<0.001）。组间比较显示，两组在术后各个时间点的腰腿痛VAS评分差异无统计学意义（P>0.05）。ODI改善率LUSE组为（84.50±2.84）%，MED组为（82.61±3.05）%，差异无统计学意义（P=0.059）。末次随访MacNab优良率LUSE组为86.67%，MED组为84.84%，差异亦无统计学意义（P=0.646）。结论：LUSE系统辅助椎间盘髓核摘除术兼具微创、高效与安全的特点。与传统的MED技术相比，该技术显著减少了手术创伤并加速了术后恢复。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of a novel L-unitary soft endoscopy(LUSE) system developed by our team in assisting discectomy for lumbar disc herniation(LDH). Methods: A retrospective cohort study was conducted on 63 patients with LDH who underwent either LUSE system-assisted discectomy(LUSE group) or microendoscopic discectomy(MED group) at our institution between June and October 2024. There were 30 cases in the LUSE group, including 17 males and 13 females, with an age of 41.83±12.50 years. There were 33 cases in the MED group, including 22 males and 11 females, with an age of 45.79±14.25 years. Perioperative outcomes including operative time, intraoperative blood loss, incision length, and postoperative hospital stay, as well as complication rate were compared between the two groups. Postoperative pain and functional recovery were assessed using the visual analog scale(VAS) score and Oswestry disability index(ODI). Clinical satisfaction at 6-month follow-up was evaluated using the modified MacNab criteria. Results: All procedures were completed successfully without major complications. Compared with the MED group, the LUSE group had significantly shorter operative time(55.17±10.77min vs 64.30±12.26min, P=0.003), shorter incision length(median 1.6cm vs 2.1cm, P<0.001), less intraoperative blood loss(median 20mL vs 30mL, P=0.018), and reduced hospital stay(median 4d vs 5d, P=0.008). VAS score and ODI significantly improved in both groups(P<0.001), with no statistically significant differences in low back and leg pain VAS scores between the two groups at each postoperative time point(P>0.05). ODI improvement rate was (84.50±2.84)% in the LUSE group and (82.61±3.05)% in the MED group, with no statistically significant difference(P=0.059). According to the modified MacNab criteria, the excellent and good outcome rates were 86.67% in the LUSE group and 84.84% in the MED group, with no statistically significant difference(P=0.646). Conclusions: The LUSE-assisted discectomy is a safe, efficient, and minimally invasive solution for lumbar disc herniation, which significantly reduces surgical trauma and speeds up postoperative recovery comparing with MED.