腰椎间盘突出症单侧双通道内镜术中是否缝合纤维环

Unilateral biportal endoscopic discectomy for lumbar disc herniation with or without annular suture

摘要:

[目的] 比较单侧双通道内镜(unilateral biportal endoscopic, UBE)髓核摘除术治疗腰椎间盘突出症(lumbar disc herniation, LDH)是否缝合纤维环的临床结果。[方法] 2023年10月—2025年2月80例LDH患者纳入本研究,均行UBE髓核摘除术。依据医患沟通结果,36例UBE髓核摘除术后给予纤维环缝合;另外44例仅行UBE髓核摘除术,未缝合纤维环。比较两组围手术期与随访资料。[结果] 两组所有患者手术顺利完成,无严重并发症。缝合组手术时间[min,(66.7±11.3) vs (53.4±12.9),P=0.032]、出血量[mL,(56.6±19.1) vs (45.6±21.3),P=0.023]均显著多于未缝合组。所有患者均随访10个月以上,随时间推移,两组腰痛和下肢痛VAS评分以及ODI评分均显著下降(P<0.05)。相应时间点,两组间腰痛和下肢痛VAS评分以及ODI评分的差异均无统计学意义(P>0.05)。随访过程中,缝合组无复发病例,未缝合组2例复发(复发率4.5%),经保守治疗症状改善,未行二次手术治疗。[结论] UBE髓核摘除术联合纤维环缝合治疗LDH,可闭合纤维环破口、有可能降低术后复发率,但会增加手术时间及出血量,临床需结合患者情况个体化选择。

Abstract:

[Objective] To compare the clinical outcomes of unilateral biportal endoscopic (UBE) discectomy for lumbar disc herniation (LDH) with and without annular repair. [Methods] From October 2023 to February 2025, a total of 80 patients with LDH were included in this study and all underwent UBE discectomy. Based on doctor-patient communication, 36 patients received annular suture after UBE discectomy, while the remaining 44 patients only underwent UBE discectomy without annular suture. The perioperative and follow-up data of the two groups were compared. [Results] All patients in both groups had the consistent surgeries performed successfully without serious complications. The suture group consumed significantly higher operation time [min, (66.7±11.3) vs (53.4±12.9), P=0.032] and blood loss [mL, (56.6±19.1) vs (45.6±21.3), P=0.023] than the non-suture group. All patients were followed up for more than 10 months. The VAS scores for low back pain and leg pain, as well as the ODI score significantly decreased in both groups over time (P<0.05), whereas which proved not statistically significant between the two groups at any time points accordingly (P>0.05). During the follow-up period, no recurrence was observed in the suture group, while 2 cases (4.5%) recurred in the non-suture group, whose symptoms improved after conservative treatment without revision surgery. [Conclusion] UBE discectomy combined with annular suture for LDH can close the annular defect and potentially reduce the recurrence rate, but it increases the operation time and blood loss. Clinical decisions should be individualized based on patient conditions.