腰椎间盘突出症两种微创手术临床比较

Clinical outcome of unilateral biportal endoscopic versus minimally invasive tubular discectomy for lumbar disc herniation

摘要:

[目的] 比较单侧双通道内镜下椎间盘切除（unilateral biportal endoscopic discectomy,UBE）与微创通道下椎间盘切除（minimally invasive tubular discectomy, MITD）两种微创手术的临床疗效。[方法] 2020年08月至2021年08月，回顾性分析166例于烟台市烟台山医院因单节段腰椎间盘突出症行UBE或MITD手术的患者，依据术前医患沟通结果，50 例采用UBE，116 例采用MITD。比较两组围手术期、随访和影像资料。[结果] UBE组手术时间长于MITD组，差异具有统计学意义(P<0.05)。前者切口长度、术中透视次数、术中失血量、住院时间均显著优于后者(P<0.05)。前者在下地时间、切口愈合优于后者，但两组间差异无统计学意义(P>0.05)。患者均随访12-24个月，平均（15.73±3.54）个月。UBE组完全负重活动时间稍短于MITD组，两组间差异无统计学意义(P>0.05)。术后随着时间的推移，两组患者VAS和ODI评分均显著降低(P<0.05)。相应时间点，两组间VAS和ODI评分差异均无统计学意义(P>0.05)。与术前相比，术后两组椎间隙高度、椎管占位面积百分比均显著下降(P<0.05)，但相应时间点两组间影像指标的差异无统计学意义(P>0.05)。[结论] 应用UBE治疗单节段腰椎间盘症可以取得和MITD相似的临床疗效，但UBE创伤更小，术中透视次数更少，住院时间进一步缩短。

Abstract:

[Objective] To compare the clinical efficacy of two minimally invasive procedures, unilateral biportal endoscopic discectomy (UBE) and minimally invasive tubular discectomy (MITD). [Methods] From August 2020 to August 2021, a retrospective review was performed in 166 patients who had underwent either UBE or MITD at Yantai Mountain Hospital in Yantai City. According to the consequences of preoperative doctor-patient communication, 50 patients underwent UBE and 116 patients underwent MITD. The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] The operation time was longer in the UBE group than in the MITD group, and the difference was statistically significant (P<0.05). The incision length, number of intraoperative fluoroscopies, intraoperative blood loss, and hospital stay were significantly better in the former than in the latter (P<0.05). The former was better than the latter in time to floor and incision healing, but the difference between the two groups had none statistical significance (P>0.05).Patients were followed up for 12-24 months with a mean of (15.73±3.54) months. The time to full weight-bearing activity was obviously shorter in the UBE group than the MITD group, and the difference between the two groups had none statistical significance (P>0.05). Postoperatively, the VAS and ODI scores decreased significantly at time in both groups (P<0.05). The differences in VAS and ODI scores between the two groups at the corresponding time points had none statistical significance (P>0.05). Compared with the preoperative period, the postoperative disc height and the percentage of occupied area of the spinal canal were significantly decreased in both groups (P<0.05), but the differences in imaging indexes between the two groups at the corresponding time points had none statistical significance (P>0.05). [Conclusion] The application of UBE for single-segment lumbar disc disease can achieve similar clinical outcomes as MITD, but UBE is less invasive, has fewer intraoperative fluoroscopic views, and further reduces hospital stay.