单侧双通道内镜与通道下腰椎间盘切除术的比较△

Unilateral biportal endoscopic discectomy versus Quadrant-channel discectomy for single-segment lumbar disc herniation

摘要:

[目的]比较单侧双通道内镜椎间盘切除（unilateral biportal endoscopic discectomy, UBED）与通道下腰椎间盘切除术 （Quadrant-channel discectomy, QCD） 治疗单节段腰椎间盘突出症的临床疗效。[方法] 回顾性分析 2021 年 6 月—2021 年 12 月本科采用微创手术治疗 61 例单节段腰椎间盘突出症患者，根据医患沟通结果，32 例采用 UBED，另外 29 例采用 QCD。比较两组患者的围手术期、随访和影像学相关资料。[结果]两组患者均顺利手术，两组各发生 1 例硬脊膜撕裂，无不良后果。虽然 UBED 组手术时间 [(58.3±7.0) min vs (42.0±6.7) min, P=0.039]、术中透视次数 [(4.5±1.0) 次 vs (3.6±1.2) 次, P=0.003] 显著大于 QCD 组，但前者切口总长度 [(2.7±0.2) cm vs (3.3±0.2) cm, P＜0.001]、术中失血量 [(45.8±12.6) ml vs (56.2±13.5) ml, P=0.003]、术后首次下地行走时间 [(2.2±0.5) d vs (2.9±0.7) d, P＜0.001] 均显著优于 QCD 组。所有患者随访 12~14 个月，平均（12.8±0.7）个月，UBED 组恢复至完全负重活动时间明显早于 QCD 组 [(6.0±1.1) 周 vs (6.7±1.1) 周, P=0.023]。随时间推移，两组患者的腰、腿痛 VAS 评分及 ODI 评分均显著下降（P＜0.05）。相应时间点，两组间上述评分的差异均无统计学意义（P＞0.05）。影像方面，与术前相比两组患者术后及末次随访时病变节段的椎管占位率均显著减少（P＜0.05），而椎间隙高度及腰椎前凸 Cobb 角无明显变化（P＞0.05），相同时间点两组之间以上影像学指标的差异均无统计学意义（P＞0.05）。[结论] 两种术式都是治疗腰椎间盘突出症的安全有效的微创手术方法，UBE 手术虽然手术时间长，透视次数多，但创伤更小，患者术后恢复更快。

Abstract:

[Objective] To compare the clinical outcomes of the unilateral biportal endoscopic discectomy (UBED) versus Quadrantchannel discectomy (QCD) in the treatment of single-level lumbar disc herniation. [Methods] A retrospective study was performed on 61 pa- tients who were treated by minimally invasive surgeries for single-segment lumbar disc herniation in our department from June 2021 to De- cember 2021. According to doctor-patient communication, 32 patients were treated by UBED, while the other 29 patients were by QCD. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had corre- sponding surgical procedures performed successfully with 1 case of dural tear in each group that not leaded serious adverse consequences. Although the UBED group consumed significantly longer operative time [(58.3±7.0) min vs (42.0±6.7) min, P=0.039] and more intraoperative fluoroscopy [(4.5±1.0) times vs (3.6±1.2) times, P=0.003] than the QCD group, the former proved significantly superior to the latter in terms of total incision length [(2.7±0.2) cm vs (3.3±0.2) cm, P＜0.001], intraoperative blood loss [(45.8±12.6) ml vs (56.2±13.5) ml, P=0.003], and postoperative walking time [(2.2±0.5) days vs (2.9±0.7) days, P＜0.001]. All patients in both groups were followed up for 12~14 months with a mean of (12.8±0.7) months, and the UBED group resumed full weight-bearing activity significantly earlier than the QCD group [(6.0±1.1) weeks vs (6.7±1.1) weeks, P=0.023]. The VAS scores for low back pain and leg pain, as well as ODI scores significantly decreased in both groups over time (P＜0.05), which proved not statistically significant between the two groups at any time point accordingly (P＞0.05). Regard- ing imaging, the spinal canal occupying rate of the involved segment was significantly decreased in both groups after surgery and at the last follow-up compared with that preoperatively (P＜0.05), while the intervertebral height and the Cobb angle of lumbar lordosis remained un- changed (P＞0.05). There were no significant differences in the above imaging indexes between the two groups at any matching time point (P＞0.05). [Conclusion] Both surgical techniques are safe and effective minimally invasive methods for the treatment of lumbar disc herniation. Although UBED consumes longer operation time and more fluoroscopy times, it takes advantages of less trauma and faster postoperative re- covery over the QCD.