[1]唐振宇,李亚浩,李子航,等.单孔分体内镜、单侧双通道内镜及经皮内镜椎间孔入路椎间盘切除术治疗游离型腰椎间盘突出症的比较研究[J].中医正骨,2024,36(06):23-31.
　TANG Zhenyu,LI Yahao,LI Zihang,et al.A comparative study of one-hole split endoscope discectomy,unilateral biportal endoscopy discectomy and percutaneous endoscopic transforaminal discectomy for treatment of sequestered lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(06):23-31.
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单孔分体内镜、单侧双通道内镜及经皮内镜椎间孔入路椎间盘切除术治疗游离型腰椎间盘突出症的比较研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年06期
页码:
23-31
栏目:
临床研究
出版日期:
2024-06-20

文章信息/Info

Title:
A comparative study of one-hole split endoscope discectomy,unilateral biportal endoscopy discectomy and percutaneous endoscopic transforaminal discectomy for treatment of sequestered lumbar disc herniation
作者:
唐振宇; 李亚浩; 李子航; 朱广晔; 王宇铖; 俞鹏飞
南京中医药大学附属苏州市中医医院,江苏 苏州 215009
Author(s):
TANG Zhenyu; LI Yahao; LI Zihang; ZHU Guangye; WANG Yucheng; YU Pengfei
Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu,China
关键词:
椎间盘移位;  腰椎;  内窥镜检查;  椎间盘切除术;  回顾性研究
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  endoscopy;  diskectomy;  retrospective studies
摘要:
目的:比较单孔分体内镜(one-hole split endoscope,OSE)、单侧双通道内镜(unilateral biportal endoscopy,UBE)、经皮内镜椎间孔入路椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗游离型腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效和安全性。方法:回顾性分析94例游离型LDH患者的病例资料,其中26例采用OSE治疗(OSE组)、37例采用UBE治疗(UBE组)、31例采用PETD治疗(PETD组)。比较3组患者的切口长度、术中X线透视次数、切皮前准备时间、镜下操作时间、手术时间、血细胞比容减少量、术中及术后1 d的总失血量、冲洗液用量、摘除髓核体积、髓核摘除比、腰部和腿部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、并发症发生率及LDH复发率。结果:①一般结果。UBE组患者切口长度大于OSE组和PETD组(P=0.000,P=0.000),OSE组患者切口长度大于PETD组(P=0.000); PETD组患者术中X线透视次数多于OSE组和UBE组(P=0.000,P=0.000),OSE组和UBE组患者术中X线透视次数的差异无统计学意义(P=0.958); PETD组患者切皮前准备时间长于OSE组和UBE组(P=0.000,P=0.000),OSE组和UBE组患者切皮前准备时间的差异无统计学意义(P=0.388); PETD组患者镜下操作时间长于UBE组和OSE组(P=0.016,P=0.022),OSE组和UBE组患者镜下操作时间的差异无统计学意义(P=0.922); PETD组患者血细胞比容减少量低于OSE组和UBE组(P=0.000,P=0.000),OSE组和UBE组患者血细胞比容减少量的差异无统计学意义(P=0.206); PETD组患者术中及术后1 d的总出血量少于OSE组和UBE组(P=0.000,P=0.000),OSE组和UBE组患者术中及术后1 d的总出血量的差异无统计学意义(P=0.220); OSE组患者冲洗液用量多于UBE组和PETD组(P=0.000,P=0.000),UBE组患者冲洗液用量多于PETD组(P=0.000); 3组患者的手术时间、摘除髓核体积、髓核摘除比的组间差异均无统计学意义。②疗效评价结果。3组患者术后1年腰部、腿部疼痛VAS评分和ODI均小于术前(Z=-4.460,P=0.000,Z=-5.304,P=0.000,Z=-4.862,P=0.000; Z=-4.460,P=0.000,Z=-5.304,P=0.000,Z=-4.864,P=0.000; Z=-4.460,P=0.000,Z=-5.306,P=0.000,Z=-4.863,P=0.000),3组患者术前、术后1年腰部、腿部疼痛VAS评分和ODI的组间差异均无统计学意义(H=0.054,P=0.973,H=0.617,P=0.734; H=1.646,P=0.439,H=5.411,P=0.067; H=0.647,P=0.526,H=0.201,P=0.904)。③安全性评价结果。OSE组与PETD组各发生神经损伤1例,UBE组发生类脊髓压迫症1例、竖脊肌肌疝1例。3组患者并发症发生率的差异无统计学意义(P=1.000)。PETD组LDH复发2例,3组患者LDH复发率的组间差异无统计学意义(P=0.181)。结论:采用OSE、UBE、PETD治疗游离型LDH的临床疗效和安全性相当,PETD的切口短、出血量和冲洗量少,而OSE和UBE的X线透视次数少、切皮前准备时间和镜下操作时间短。
Abstract:
Objective:To compare the clinical outcomes and safety of one-hole split endoscope(OSE)discectomy,unilateral biportal endoscopy(UBE)discectomy and percutaneous endoscopic transforaminal discectomy(PETD)in treatment of sequestered lumbar disc herniation(LDH).Methods:The medical records of 94 patients with sequestered LDH were retrospectively analyzed.Twenty-six patients were treated with OSE discectomy(OSE group),37 ones with UBE discectomy(UBE group),and 31 ones with PETD(PETD group).The incision length,intraoperative X-ray exposure,pre-incision preparation time,endoscopic operation time,total operative time,reduction of hematocrit,total blood loss during the procedure and at postoperative day 1,consumption of irrigation fluid,volume of removed nucleus pulposus,removal ratio of nucleus pulposus,lumbago-leg pain visual analogue scale(VAS)score,Oswestry disability index(ODI),complication incidence and LDH recurrence rate were compared among the 3 groups.Results:①The incision length was longer in UBE group compared to OSE group and PETD group(P=0.000,P=0.000),and was longer in OSE group compared to PETD group(P=0.000).The intraoperative X-ray exposure was more in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,the comparison between OSE group and UBE group revealed no significant differences(P=0.958).The pre-incision preparation time was longer in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,the comparison between OSE group and UBE group revealed no significant differences(P=0.388).The endoscopic operation time was longer in PETD group compared to UBE group and OSE group(P=0.016,P=0.022),while,the comparison between OSE group and UBE group revealed no significant differences(P=0.922).The reduction of hematocrit was lower in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,there was no statistical difference between OSE group and UBE group(P=0.206).The total blood loss during the procedure and at postoperative day 1 was less in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,there was no statistical difference between OSE group and UBE group(P=0.220).The consumption of irrigation fluid was more in OSE group compared to UBE group and PETD group(P=0.000,P=0.000),and was more in UBE group compared to PETD group(P=0.000).There was no statistical difference in total operative time,volume of removed nucleus pulposus and removal ratio of nucleus pulposus among the 3 groups.②The lumbago-leg pain VAS score and ODI decreased at postoperative month 12 compared to pre-operation in the 3 groups(Z=-4.460,P=0.000,Z=-5.304,P=0.000,Z=-4.862,P=0.000; Z=-4.460,P=0.000,Z=-5.304,P=0.000,Z=-4.864,P=0.000; Z=-4.460,P=0.000,Z=-5.306,P=0.000,Z=-4.863,P=0.000),while,the differences were not statistically significant in lumbago-leg pain VAS score and ODI evaluated at pre-operation and postoperative month 12 among the 3 groups(H=0.054,P=0.973,H=0.617,P=0.734; H=1.646,P=0.439,H=5.411,P=0.067; H=0.647,P=0.526,H=0.201,P=0.904).③One patient in OSE group and one patient in PETD group suffered from nerve injury,meanwhile,the spinal cord compression-like syndrome and erector spinae muscle hernia were found in one patient respectively in UBE group.The difference in complication incidence was not statistically significant among the 3 groups(P=1.000).The recrudescent LDH were found in 2 patients in PETD group,the difference in the recurrence rate of LDH was not statistically significant among the 3 groups(P=0.181).Conclusion:The OSE discectomy,UBE discectomy and PETD are similar to each other in clinical outcomes and safety in treatment of sequestered LDH.The PETD displays the advantages of shorter incision,less blood loss and consumption of irrigation fluid compared to the former two,whereas,the former two exhibit fewer intraoperative X-ray exposure,shorter pre-incision preparation time and endoscopic operation time compared to PETD.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(82004393); 苏州市科技发展计划项目(SKY2023066); 苏州市姑苏卫生人才计划人才科研项目(GSWS2021049)
通讯作者:俞鹏飞 E-mail:yupengfei86@163.com
更新日期/Last Update: 1900-01-01