单侧双通道内镜下与经皮椎板间入路内镜下椎间盘切除术治疗L5/S1椎间盘突出症的短期临床疗效比较

doi:10.13418/j.issn.1001-165x.2023.5.17

摘要/Abstract

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）与经皮椎板间入路内镜下椎间盘切除术（percutaneous endoscopic interlaminar discectomy，PEID）治疗L5/S1椎间盘突出症的短期临床疗效。方法回顾性分析本院2020年1月至2022年8月分别应用UBED和PEID治疗L5/S1椎间盘突出症患者39例，其中UBED组24例，PEID组15例。比较两组患者围手术期指标、并发症及术后3 d、1月和6月功能。结果 UBED组1例术中出现硬膜囊破裂，1例术后出现头痛；PEID组1例术后早期出现S1神经根支配区烧灼样疼痛。UBED组切口长度（32.6±3.9）mm大于PEID组（9.8±1.3）mm，P<0.05；灌洗液使用量（11.1±2.3）L大于PEID组（6.5±1.1）L，P<0.05；术后血清肌酸激酶（351.8±99.9）U/L高于PEID组（241.4±49.6）U/L，P<0.05；手术时间（91.5±14.8）min短于PEID组（130.4±13.8）min，P<0.05。术中透视次数、术中出血量、术后住院时间及并发症，两组无统计学差异（P>0.05）。术后3 d、1月及6月的腰腿痛视觉模拟量表（visual analogue scale，VAS）和Oswestry功能障碍指数，两组患者均较术前明显下降（P<0.05），两组间无统计学差异（P>0.05）。结论 UBED与PEID均为治疗L5/S1椎间盘突出症安全、有效的微创手术方式，可有效减少术中透视次数且获得相似的疼痛缓解，改善患者的生活质量。UBED术野开阔且操作空间更大，PEID创伤更小。

关键词: 腰椎间盘突出症； , , 单侧双通道内镜下椎间盘切除术； , , 经皮椎板间入路内镜下椎间盘切除术

Abstract: Objectives To compare the short-term clinical efficacy of unilateral biportal endoscopic discectomy(UBED) and percutaneous endoscopic interlaminar discectomy(PEID) in the treatment of L5/S1 lumbar disc herniation(LDH). Methods From January 2020 to August 2022, 39 patients with L5/S1 LDH were treated with UBED or PEID in our hospital, including 24 cases in UBED group and 15 cases in PEID group. The operation time, incision length, intraoperative fluoroscopy times, intraoperative blood loss, volume of lavage fluid, changes in creatine kinase (CK) before and after surgery, postoperative hospital stay and complications were recorded and compared between the two groups. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate and compare the quality of life of patients in the two groups before operation, 3 days after operation, 1 month after operation and 6 months after operation. Results In UBED group, 1 patient had dural sac rupture during operation and 1 patient had headache after operation. One patient in PEID group had burning pain in S1 nerve root innervation area in the early postoperative period. The incision length in UBED group was longer than that in PEID group (32.6±3.9 mm vs 9.8±1.3 mm, P<0.05), and the volume of lavage fluid used was more than that in PEID group (11.1±2.3 L vs 6.5±1.1 L, P<0.05). The postoperative CK was higher than that in PEID group (351.8±99.9 U/L vs 241.4± 49.6 U/L, P<0.05), and the operation time was shorter than that in PEID group (91.5±14.8 min vs 130.4±13.8 min, P<0.05). There was no significant difference between the two groups in intraoperative fluoroscopy times, intraoperative blood loss, postoperative hospital stay and complications (P>0.05). VAS score and ODI at 3 days, 1 month and 6 months after operation were significantly lower in both groups than those before operation (P<0.05), and there was no statistical difference between the two groups (P>0.05). Conclusions UBED and PEID are both safe and effective minimally invasive surgical methods for the treatment of L5/S1 LDH, which can effectively reduce the number of intraoperative fluoroscopy and obtain similar pain relief, and improve the quality of life of patients. UBED has wider surgical field and larger operating space, while PEID has less trauma.

Key words: Lumbar disc herniation, Unilateral biportal endoscopic discectomy, Percutaneous endoscopic interlaminar discectomy

中图分类号:

R681

陈文锦, 张树军, 彭伟, 庄胤, 崔巍, 孙振中. 单侧双通道内镜下与经皮椎板间入路内镜下椎间盘切除术治疗L5/S1椎间盘突出症的短期临床疗效比较[J]. 中国临床解剖学杂志, 2023, 41(5): 593-598.

Chen Wenjin, Zhang Shujun, Peng Wei, Zhuang Yin, Cui Wei, Sun Zhenzhong. Short-term clinical efficacy comparison of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for L5/S1 lumbar disc herniation[J]. Chinese Journal of Clinical Anatomy, 2023, 41(5): 593-598.

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