单侧双通道与单通道内镜腰椎间盘切除术比较

Discectomy with unilateral biportal endoscopy versus uniportal interlaminar endoscopy for single-segment lumbar disc her⁃ niation

摘要:

[目的] 探讨单侧双通道内镜术 （unilateral biportal endoscopy, UBE） 与单通道经椎板间内镜 （uniportal interlaminar endoscopy, UIE） 腰椎间盘切除术治疗腰椎间盘突出症 （lumbar disc herniation, LDH） 的效果。[方法] 回顾性分析 2020 年 8 月 —2021 年 8 月内镜手术治疗 LDH 63 例患者的临床资料。依据术前医患沟通结果，32 例采用 UBE 术，另外 31 例采用 UIE 术。 比较两组患者的围手术期、随访和影像资料。[结果] UBE 组手术时间 [(83.2±10.3)min vs (71.8±8.9)min, P＜0.05]、切口总长度 [(1.5±0.2)cm vs (1.2±0.2)cm, P＜0.05]、术中失血量 [(30.0±2.0)ml vs (20.0±1.6)ml, P＜0.05]、下地行走时间 [(2.5±0.5)d vs (1.6±0.2)d, P＜ 0.05] 及住院时间 [(5.1±0.6)d vs (4.0±0.4)d, P＜0.05] 均显著大于 UIE 组，两组术中透视次数和切口愈合等级的差异无统计学意义 （P＞0.05）。两组患者均获随访 12 个月以上。随时间推移两组腰痛 VAS 评分、腿痛 VAS 评分和 ODI 评分均显著降低（P＜0.05）。 术后 1 个月时 UBE 组的腰痛 VAS 评分 [(2.2±0.4) vs (2.5±0.5), P＜0.05]、腿痛 VAS 评分 [(2.4±0.6) vs (2.8±0.7), P＜0.05] 和 ODI 评分 [(20.2±2.9) vs (22.5±2.5), P＜0.05] 均显著优于 UIE 组；术后 6 个月和末次随访时，两组间腰痛 VAS 评分、腿痛 VAS 评分和 ODI 评分的差异已无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时两组患者椎管占位率显著下降（P＜0.05），椎间隙高度无显著变化（P＞0.05），腰椎前凸角显著增大（P＜0.05）。末次随访时 UBE 椎管占位率 [(12.3±3.2)% vs (15.5±4.3)%, P＜0.05] 和腰椎前凸角 [(52.3±6.2)° vs (47.8±5.9)°, P＜0.05] 均显著优于 UIE 组。[结论] UBE 与 UIE 均为治疗 LDH 的有效术式，两者疗效相当。 相比之下 UIE 术的手术损伤更小，但 UBE 的减压效果更好。

Abstract:

[Objective] To compare the clinical outcomes of discectomy with unilateral biportal endoscopy (UBE) versus uniportal inter- laminar endoscopy (UIE) for single-segment lumbar disc herniation (LDH). [Methods] A retrospective study was conducted on 63 patients who underwent endoscopic discectomy in our department from August 2020 to August 2021. According to the preoperative doctor-patient communication, 32 patients received UBE, while the remaining 31 patients received UIE. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] The UBE group proved significantly poorer than the UIE group in terms of operating time [(83.2±10.3)min vs (71.8±8.9)min_, P＜0.05], the total length of incision [(1.5±0.2)cm vs (1.2±0.2)cm, P＜0.05], intraoperative blood loss [(30.0±2.0)ml vs (20.0±1.6)ml, P＜0.05], the ambulation time [(2.5±0.5)days vs (1.6±0.2)days, P＜0.05] and hospital stay [(5.1±0.6)days vs (4.0±0.4)days, P＜0.05], nevertheless there were no significant differences in intraoperative fluoroscopy times and incision healing grade be- tween the two groups (P＞0.05). All of them in both groups were followed up for more than 12 months. VAS scores both for back pain and leg pain, as well as ODI score significantly decreased over time in both groups (P＜0.05). The UBE group was significantly better than the UIE group in terms of VAS score for lumbago [(2.2±0.4) vs (2.5±0.5), P＜0.05] and VAS score of leg pain [(2.4±0.6) vs (2.8±0.7), P＜0.05] and ODI score [(20.2±2.9) vs (22.5±2.5), P＜0.05] a month postoperatively, whereas which became not statistically significant between the two groups at 6 months postoperatively and the latest follow-up. Regarding imaging, the spinal canal occupying ratio significantly decreased (P＜0.05) and intervertebral height remained unchanged (P＞0.05), and the lumbar lordosis increased significantly (P＜0.05) in both group at the latest follow- up compared with those preoperatively. By the time of the last follow- up, the UBE group proved significantly superior to the UIE group in terms of canal occupying ratio [(12.3±3.2)% vs (15.5±4.3)%, P＜0.05] and lumbar lordosis [(52.3±6.2)° vs (47.8±5.9)°, P＜0.05].[Conclusion] Both UBE and UIE are effective in the treatment of LDH, with comparable clinical consequences. By comparison, the UIE is less invasive, while the UBE is more effective decompression.