腰椎侧隐窝狭窄伴椎间盘突出症两种内镜术比较△

Comparison of two kinds of endoscopic surgery for lumbar lateral recess stenosis accompanied with disc herniation

摘要:

［目的］ 比较单侧双通道内镜术 （unilateral biportal endoscopy spinal surgery, UBE） 与经皮椎板间入路内镜术 （percu- taneous interlaminar endoscopic discectomy, PIED）治疗腰椎侧隐窝狭窄伴椎间盘突出症的临床疗效。［方法］回顾性分析 2018 年 11 月—2020 年 11 月收治的 60 例单节段腰椎侧隐窝狭窄伴椎间盘突出患者的临床资料，按术前医患沟通结果分为两组，30 例行 UBE 术，30 例行 PIED 术，比较两组围手术期、随访及辅助检查资料。［结果］ UBE 组手术时间显著少于 PIED 组 （P< 0.05），切口总长度大于 PIED 组（P<0.05）。两组间术中失血量、透视次数、下地行走时间、切口愈合等级、住院时间差异均无统计学意义（P>0.05）。两组术后随访时间平均（21.48±6.82）个月，两组完全负重活动时间的差异无统计学意义（P>0.05）。随时间推移，两组腰痛、腿痛 VAS 和 ODI 评分均显著降低（P<0.05），而 JOA 评分显著增加（P<0.05）。相应时间点，两组间腰痛、腿痛 VAS 和 ODI、JOA 评分的差异均无统计学意义（P>0.05）。辅助检查方面，与术前相比，两组术后肌红蛋白浓度、侧隐窝前后径及椎管面积均显著增加（P<0.05），椎间隙高度无显著变化（P>0.05），相应时间点，两组间辅助检查指标的差异均无统计学意义（P>0.05）。［结论］UBE 与 PIED 治疗腰椎侧隐窝狭窄伴椎间盘突出症均微创有效，但 UBE 手术时间更短。

Abstract:

[Objective] To compare the clinical outcomes of unilateral biportal endoscopy (UBE) versus percutaneous interlaminar endo- scopic discectomy (PIED) for lumbar lateral recess stenosis accompanied with disc herniation. [Methods] A total of 60 patients received en- doscopic surgeries for single-segment lumbar lateral recess stenosis accompanied by disc herniation in our hospital from November 2018 to November 2020. Based on preoperative doctor- patient communication, 30 patients had UBE performed, while the other 30 patients had PIED conducted. The documents regarding to perioperative period, follow-up and laboratory and imaging examinations were compared be- tween the two groups. [Results] The UBE group consumed significantly shorter operation time, whereas had significantly longer incision than the PIED group (P＜0.05) , although there were no statistical differences between the two groups in terms of blood loss, fluoroscopy times, time to return walking postoperatively, healing grade of incision and hospital stay (P＞0.05) . There was no significant difference in the time to re- sume full-weight bearing activity between the two groups (P＞0.05) . As time went during follow-up lasted for (21.48±6.82) months on an aver- age, the VAS scores of low back pain and leg pain, as well as ODI scores decreased significantly (P＜0.05) , whereas the JOA scores increased significantly in both groups (P＜0.05) . However, there were no statistically significant differences in abovementioned items between the two groups at any matching time points (P＞0.05) . In terms of auxiliary examinations, the blood myoglobin, anteroposterior diameter of lateral re- cess and the area of the involved spinal canal increased significantly (P＜0.05) , while the intervertebral space height remained unchanged postoperatively compared with those preoperatively in both groups (P＞0.05) , which were not statistically significantly different between the two groups at any corresponding time points (P＞0.05) . [Conclusion] Both UBE and PIED are effective and minimally invasive techniques for lumbar lateral recess stenosis accompanied with disc herniation, but UBE takes an advantage of shortening operation time.