单侧双通道内镜治疗脱垂游离型腰椎间盘突出症

Unilateral biportal endoscopy for sequestrated lumbar disc herniation

摘要:

[目的]探讨单侧双通道内镜（unilateral biportal endoscopy, UBE）治疗脱垂游离型腰椎间盘突出症 (sequestrated lum- bar disc herniation, SLDH) 的安全性和临床疗效。[方法] 回顾性分析 2020 年 7 月—2021 年 10 月应用 UBE 治疗的 27 例 SLDH 患者的临床资料。均采用俯卧位全麻下 UBE 摘除脱垂游离的髓核组织，评价临床及影像结果。[结果]27 例患者均顺利完成手术，手术时间平均（88.5±12.8）min，术中均未发生血管、神经损伤、类脊髓高压反应等相关并发症，硬脊膜撕裂 1 例。随访时间平均 （19.2±4.0） 个月。随着术前、术后 6 个月和末次随访的时间推移，腰痛 VAS 评分 [(3.2±1.8), (0.8±0.5), (0.2±0.2), P＜ 0.001]、腿痛 VAS 评分 [(7.8±1.1), (1.0±0.4), (0.4±0.4), P＜0.001] 和 ODI 评分 [(74.4±5.3), (17.8±1.3), (10.7±1.3), P＜0.001] 显著减少， JOA 评分 [(14.5±2. 7), (22.6±3.1), (25.9±2.8), P＜0.001] 显著增加。至末次随访时，复发 1 例，按改良 MacNab 疗效评定标准优良率 96.3%。影像学方面，随时间推移椎管占位率 [(56.4±13.3)%, (8.9±3.0)%, (8.9±3.0)%, P＜0.001] 显著下降，手术节段椎间隙高度和腰椎前凸角无明显变化（P＞0.05）。[结论]单侧双通道内镜治疗脱垂游离型腰椎间盘突出症安全有效，临床效果满意。

Abstract:

[Objective] To evaluate the safety and clinical efficacy of unilateral biportal endoscopy (UBE) for sequestrated lumbar disc herniation (SLDH). [Methods] A retrospective study was conducted on 27 patients who received endoscopic discectomy of SLDH from July 2020 to October 2021. All the patients had the prolapsed free nucleus pulposus tissue removed by UBE under general anesthesia in prone position, and the clinical and imaging results were evaluated. [Results] All the 27 patients were operated successfully, with the average operation time of (88.5±12.8) min, with no vascular, nerve injury, spinal hyperbaric reaction and other related complications occurred during the operation, despite of dural tear in a case. As time went from that preoperative to 6 months postoperatively and the last follow-up, which was lasted for the average of (19.2±4.0) months, the VAS score for the low back pain [(3.2±1.8), (0.8±0.5), (0.2±0.2), P＜0.001], VAS score for leg pain [(7.8±1.1), (1.0±0.4), (0.4±0.4), P＜0.001] and ODI scores [(74.4±5.3), (17.8±1.3), (10.7±1.3), P＜0.001] significantly reduced, whereas the JOA score significantly increased [(14.5±2.7), (22.6±3.1), (25.9±2.8), P＜0.001]. At the last follow-up, only one patient got recurrence, and the excellent rate of clinical outcome was 96.3% based on the modified MacNa's criteria. As for imaging, the spinal canal occupied rate decreased significantly over time [(56.4±13.3)%, (8.9±3.0)%, (8.9±3.0)%, P＜0.001], while the disc height and lumbar lordotic angle of the involved level remained unchanged significantly (P＞0.05). [Conclusion] The unilateral biportal endoscopy is safe and effective in the treatment of sequestrated lumbar disc herniation, and achieves satisfactory clinical outcomes.