两种内镜椎间盘切除术临床比较

Clinical comparison of two kinds of endoscopic discectomy

摘要:

[目的] 比较单侧双通道内镜（unilateral biportal endoscopy, UBE） 和椎间孔镜（percutaneous endoscopic transforami-nal discectomy, PETD） 治疗腰椎间盘突出症的临床疗效。[方法] 回顾性分析2019 年2 月—2020 年9 月采用内镜椎间盘切除术治疗的67 例腰椎间盘突出症患者的临床资料，根据医患沟通结果，28 例采用UBE 组术，另外39 例采用PETD 术，比较两组围手术期、随访及影像结果。[结果] 所有患者均顺利完成手术，UBE 组手术时间[(58.1±10.6) min vs (65.5±11.3) min, P=0.009]、术中透视次数[(3.1±1.1) 次vs (5.2±1.2) 次, P＜0.001] 显著少于PETD 组，但前切口长度[(2.3±0.2) cm vs (1.2±0.2) cm, P＜0.001] 和椎间盘切除量[(3.5±1.1) cm3 vs (2.8±1.1) cm3, P=0.011] 显著大于后者。随访时间平均（10.5±2.0） 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VAS 及ODI 评分均显著改善（P＜0.05）。术后1 个月UBE 组的腰痛VAS [(2.3±0.7) vs(2.7±0.6), P=0.028] 及ODI [(27.1±4.9) vs (29.7±5.3), P=0.045] 显著优于PETD 组。影像方面，两组患者术后神经根压迫Pfirrmann 分级均显著改善（P＜0.05），椎管横截面积（cross-sectional area of canal, CSAC） 显著增加（P＜0.05），而椎间孔面积无显著变化（P＞0.05）。术后UBE 组的CSAC 显著优于PETD 组[(184.4±40.6) mm2 vs (137.0±28.9) mm2, P＜0.001]。[结论] 单侧双通道内镜技术作为一种新的脊柱内镜技术，创伤小，减压充分，有利于患者早期恢复。

Abstract:

[Objective] To compare the clinical consequences of unilateral biportal endoscopy (UBE) versus percutaneous endoscopictransforaminal discectomy (PETD) for lumbar disc herniation. [Methods] A retrospective study was done on 67 patients who received endo-scopic discectomy for lumbar disc herniation from February 2019 to September. According to the results of doctor-patient communication,28 patients were treated with UBE, while other 39 cases were with PETD. The perioperative period, follow-up and imaging data of the twogroups were compared. [Results] All patients in both groups were successfully operated on. The UBE group proved significantly less than thePETD group in terms of operative time [(58.1±10.6) min vs (65.5±11.3) min, P=0.009] and intraoperative fluoroscopy times [(3.1±1.1) timesvs (5.2±1.2) times, P＜0.001]. However, the former was significantly greater than the latter in terms of incision length [(2.3±0.2) cm vs (1.2±0.2) cm, P＜0.001] and the disc volume removed [(3.5±1.1) cm3 vs (2.8±1.1) cm3, P=0.011]. The average follow-up time was (10.5±2.0)months, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). TheVAS and ODI scores in both groups were significantly improved over time (P＜0.05). The UBE group was significantly superior to the PETDgroup in terms of the lower back pain VAS [(2.3±0.7) vs (2.7±0.6), P=0.028] and ODI [(27.1±4.9) vs (29.7±5.3), P=0.045] one month postoperatively. As for imaging, the Pfirrmann grade of nerve root compression was significantly improved (P＜0.05), and the cross-sectional area ofcanal (CSAC) was significantly increased (P＜0.05), while the CSA of the foraminal area remained unchanged in both groups postoperativelycompared with those preoperatively (P＞0.05). The UBE group was also better than the PETD group regarding postoperative CSAC [(184.4±40.6) mm2 vs (137.0±28.9) mm2, P＜0.001]. [Conclusion] As a new spinal endoscopy technique, unilateral biportal endoscopy has advantag-es of less trauma and full decompression, is conducive to early recovery of patients.