两种内镜椎间盘切除术早期临床结果比较

Comparison of early clinical results of two kinds of endoscopic discectomy

摘要:

[目的] 比较经皮内镜椎板间椎间盘切除术（percutaneous endoscopic interlaminar discectomy, PEID） 和单侧双通道内镜（unilateral biportal endoscopy, UBE） 腰椎间盘切除术的早期疗效。[方法] 回顾性分析2016 年6 月—2022 年12 月因腰椎间盘突出症行内镜下椎板间入路腰椎间盘切除术的60 例患者资料，根据不同时期开展的技术，30 例采用PEID 术，30 例采用UBE 术。比较两组围手术期、随访结果。[结果] 所有患者均顺利实施手术，术中无严重神经损伤并发症发生。PEID 组手术时间[(42.4±14.2) min vs (118.5±23.8) min, P＜0.001]、切口长度[(1.1±0.2) cm vs (2.4±0.3) cm, P＜0.001]、术中失血量[(16.2±11.0) ml vs(39.8±6.5) ml, P＜0.001]、术中透视次数[(3.8±0.9) 次vs (7.2±2.0) 次, P＜0.001]、术后下地时间[(1.2±0.3) d vs (2.3±0.6) d, P＜0.001]、住院时间[(4.8±2.3) d vs (6.2±2.1) d, P=0.016] 均显著优于UBE 组。术后第3 d，PEID 组腰痛VAS 评分显著优于UBE 组[(1.8±0.75) vs (2.4±1.1) , P=0.021]；随时间推移，两组患者腰痛VAS、腿痛VAS 和ODI 评分较均显著下降（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。根据改良Macnab 标准，PEID 组优良率为90.0%，UBE 组为86.6%，两组差异无统计学意义（P＞0.05）。[结论] PEID 的手术创伤小于UBE，但UBE 有更宽阔的视野，有利于镜下精细操作。

Abstract:

[Objective] To compare the early clinical consequences of percutaneous endoscopic interlaminar discectomy (PEID) versusunilateral biportal endoscopy (UBE) for lumbar disc herniation. [Methods] A retrospective study was done on 60 patients who underwentendoscopic discectomy for lumbar disc herniation from June 2016 to December 2022. According to the technology developed in different pe-riods, 30 patients underwent PEID and 30 patients underwent UBE. The perioperative and follow-up results were compared between thetwo groups. Clinical outcomes were assessed by the visual analogue scale (VAS), Oswestry disability index (ODI) score, and modifiedMacnab criteria at different follow-up times. [Results] All patients were successfully operated, with no complications of severe nerve injuryduring the operation. The PEID group proved significantly superior to UBE group in terms of operation time [(42.4±14.2) min vs (118.5±23.8) min, P＜0.001], incision length [(1.1±0.2) cm vs (2.4±0.3) cm, P＜0.001], intraoperative blood loss [(16.2±11.0) ml vs (39.8± 6.5) ml, P＜0.001], intraoperative fluoroscopy times [(3.8±0.9) times vs (7.2±2.0) times, P＜0.001], postoperative walking time [(1.2±0.3) days vs (2.3±0.6) days, P＜0.001] and hospital stay [(4.8±0.3) days vs (6.2±2.1) days, P=0.016]. In addition, the PEID was also significantly superior tothe UBE group in VAS score for pain 3 days after surgery [(1.8±0.8) vs (2.4±1.1), P=0.021]. The VAS scores for lower back and leg pain, aswell as ODI score significantly decreased in both groups over time (P＜0.05), whereas which were not significant between the two groups at 1month, 6 months postoperatively and the latest follow-up (P＞0.05). According to the modified Macnab's criteria, the excellent and good rateof clinical outcome was 90.0% in the PEID group, whereas 86.6% in the UBE group, which was not statistically significant between the twogroups (P＞0.05). [Conclusion] The PEID takes an advantage of less surgical trauma, while the UBE has a benefit of wider field of view to fa-cilitate fine operation under the endoscope.