摘要
目的探讨单侧双通道脊柱内镜髓核摘除术(unilateral biportal endoscopic discectomy,UBED)与经皮内镜髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)和传统椎板间开窗髓核摘除术(fenestration discectomy,FD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法回顾性分析2017年1月—2021年12月符合选择标准的347例行单纯髓核摘除术治疗的LDH患者临床资料。根据手术方式不同分为FD组(160例)、PELD组(86例)、UBED组(101例)。3组患者性别、年龄、手术节段分布、病程以及术前下肢疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)等一般资料比较差异均无统计学意义(P>0.05)。记录并比较3组患者手术时间、住院时间、治疗费用及手术相关并发症发生情况;通过手术前后下肢VAS评分和ODI评价患者疼痛和功能恢复情况。结果FD组手术时间明显短于PELD组与UBED组,住院时间明显长于PELD组与UBED组(P<0.05);PELD组和UBED组间差异无统计学意义(P>0.05)。UBED组治疗费用明显高于PELD组,PELD组高于FD组,差异均有统计学意义(P<0.05)。3组患者均获随访,随访时间6~24个月,平均14.6个月。3组患者术后下肢VAS评分和ODI均较术前显著改善(P<0.05)。术后1 d UBED组下肢VAS评分明显优于PELD组和FD组(P<0.05),PELD组与FD组间差异无统计学意义(P>0.05);术后1、3个月下肢VAS评分3组间差异无统计学意义(P>0.05)。ODI手术前后差值FD组和UBED组略优于PELD组(P<0.05),FD组与UBED组间比较差异无统计学意义(P>0.05)。FD组手术相关并发症发生率(20.0%)明显高于PELD组(12.8%)和UBED组(6.9%),PELD组高于UBED组(P<0.05)。切口感染均发生于FD组(12例),症状性椎间盘囊肿和类脊髓高压症各1例均发生于PELD组。结论UBED、PELD和FD治疗LDH早期缓解下肢疼痛疗效相当;与FD相比,UBED与PELD具有住院时间短、并发症少的优势。
Objective To investigate the effectiveness of unilateral biportal endoscopic discectomy(UBED),percutaneous endoscopic lumbar discectomy(PELD),and traditional fenestration discectomy(FD)in the treatment of lumbar disc herniation(LDH).Methods The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed.They were divided into FD group(160 cases),PELD group(86 cases),and UBED group(101 cases)according to operation methods.There was no significant difference in gender,age,surgical level distribution,disease duration,and preoperative visual analogue scale(VAS)score and Oswestry disability index(ODI)between groups(P>0.05).The operation time,hospitalization stay,treatment cost,and incidence of surgery-related complications were recorded and compared between groups.The patients’pain and functional recovery were evaluated by VAS score and ODI before and after operation.Results The operation time of FD group was significantly shorter than that of PELD group and UBED group,and the hospitalization stay was significantly longer than that of PELD group and UBED group(P<0.05);there was no significant difference between PELD group and UBED group(P>0.05).The treatment cost in UBED group was significantly higher than that in PELD group,and in PELD group than in FD group(P<0.05).All the patients were followed up 6-24 months,with an average of 14.6 months.VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation(P<0.05).At 1 day after operation,VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group(P<0.05),but there was no significant difference between PELD group and FD group(P>0.05).There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation(P>0.05).The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group(P<0.05),and there was no significant difference between FD group and UBED group(P>0.05).Incidence of surgery-related complications in FD group(20.0%)was significantly higher than that in PELD group(12.8%)and UBED group(6.9%),and PELD group was significantly higher than UBED group(P<0.05).All the incision infection occurred in FD group(12 cases),symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group.Conclusion UBED,PELD,and FD have similar effectiveness on lower extremity pain in early LDH.Compared with FD,UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.
作者
王海峰
宋扬
王乃国
WANG Haifeng;SONG Yang;WANG Naiguo(Department of Spinal Surgery,Provincial Hospital Afiliated to Shandong First Medical University,Jinan Shandong,250021,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第10期1200-1206,共7页
Chinese Journal of Reparative and Reconstructive Surgery
