腰椎间盘突出症两种微创手术临床比较

Comparison of two minimally invasive surgeries for lumbar intervertebral disc herniation

摘要:

[目的]比较单侧双通道内镜下椎间盘切除（unilateral biportal endoscopic, UBE）与微创通道下椎间盘切除（minimal- ly invasive tubular discectomy, MITD） 治疗单节段腰椎间盘突出症的临床疗效。[方法] 回顾性分析 2020 年 8 月—2021 年 8 月 166 例于本院行单节段微创腰椎间盘突切除术患者的临床资料。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 组手术时间显著长于 MITD 组 [(107.9±19.0) min vs (63.2±11.0) min, P＜0.05]， 但是，UBE 组切口长度 [(2.0±0.2) cm vs (2.8±0.3) cm, P＜0.05]、术中透视次数 [(2.7±0.8) 次 vs (3.2±1.1) 次, P＜0.05]、术中失血量 [(30.8±15.6) ml vs (42.0±22.3) ml, P＜0.05]、住院时间 [(8.7±2.1) d vs (10.2±3.9) d, P＜0.05] 均显著少于 MITD 组 。两组下地时间、切口愈合等级的差异无统计学意义（P＞0.05）。所有患者随访时间平均（15.7±3.5）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，两组患者腰痛 VAS 评分、腿痛 VAS 评分和 ODI 评分均显著减少（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）。影像方面，与术前相比，术后 1、6 个月、末次随访时，两组椎间隙高度、椎管占位面积百分比均显著减少（P＜0.05）；但相应时间点两组间上述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与 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 clinical efficacy of unilateral biportal endoscopic discectomy (UBE) versus minimally invasive tubu- lar discectomy (MITD) for single-segment intervertebral disc herniation. [Methods] A retrospective study was done on 166 patients who un- derwent minimally invasive lumbar discectomy for single-level disc protrusion in our hospital from August 2020 to August 2021. According to preoperative doctor-patient communication, 50 patients were treated with UBE, while the remaining 116 patients received MITD. Periop- erative, follow-up and imaging data were compared between the two groups. [Results] Although the UBE consumed significantly longer oper- ation time than the MITD group [(107.9±19.0) min vs (63.2±11.0) min, P＜0.05], the former proved significantly less than the latter in terms of incision length [(2.0±0.2) cm vs (2.8 ± 0.3) cm, P＜0.05], intraoperative fluoroscopy times [(2.7±0.8) vs (3.2±1.1) times, P＜0.05], intraopera- tive blood loss [(30.8±15.6) ml vs (42.0±22.3) ml, P＜0.05], and hospital stay [(8.7±2.1) days vs (10.2±3.9) days, P＜0.05]. There was no signif- icant difference in postoperative ambulation time and incision healing grade between the two groups (P＞0.05). All the patients in both groups were followed up for (15.7±3.5) months on a mean, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). The VAS scores both for lower back pain and leg pain, as well as ODI score decreased significantly in both groups with time (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). With re- gard to imaging, the height of intervertebral space and the percentage of vertebral canal occupying area significantly reduced in both groups at 1 month, 6 months and the last follow-up after surgery compared with those preoperatively (P＜0.05), whereas which proved not significant- ly different between the two groups at the corresponding time points (P＞0.05). [Conclusion] The UBE used in the treatment of single-level lumbar disc disease does achieve similar clinical efficacy as MITD. By contrast, the UBE has less trauma, fewer intraoperative fluoroscopy, and further shortened hospital stay.