摘要
目的:比较经皮内镜椎间孔入路腰椎间盘髓核摘除术(percutaneous endoscopic transforaminal discectomy,PETD)、经皮内镜椎板间入路腰椎间盘髓核摘除术(percutaneous endoscopic interlaminar discectomy,PEID)和单侧双通道内镜(unilateral biportal endoscopic,UBE)技术在单节段腰椎间盘突出症(lumbar disc herniation,LDH)中的临床疗效及并发症发生率。方法:回顾性分析2019年10月至2021年8月采用脊柱内镜治疗的121例单节段LDH患者,根据治疗方法不同分为3组。PETD组48例,男19例,女29例;年龄18~72(44.0±13.9)岁;L3,4节段3例,L4,5节段27例,L5S1节段18例;PEID组43例,男23例,女20例;年龄20~69(40.1±12.1)岁;L3,4节段1例,L4,5节段15例,L5S1节段27例;UBE组30例,男12例,女,18例;年龄29~72(41.2±15.0)岁;L3,4节段1例,L4,5节段18例,L5S1节段11例。观察并比较3组手术时间、出血量、透视次数、并发症等情况。分别于术前、术后3个月及末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)进行腰痛及下肢痛评估,采用Oswestry功能障碍指数(Oswestry disfunction index,ODI)进行腰椎功能评价,并于末次随访时采用改良MacNab标准评价临床疗效。结果:所有患者完成脊柱内镜手术治疗,并经门诊及(或)电话进行至少12个月的随访。PETD、PEID组术中各发生1例硬膜囊破裂,硬膜囊破口小,术后均无明显不适。UBE组术中发生2例硬膜囊破裂;1例术后出现脑脊液漏,平卧位休息、补液等治疗后好转;1例术后无明显不适。(1)PETD组与PEID组手术时间、出血量及住院日比较,差异无统计学意义(P>0.05),UBE组手术时间、出血量及住院日多于PETD及PEID组(P<0.05)。PEID组与UBE技术组透视次数比较,差异无统计学意义(P>0.05),PETD组透视次数多于PEID组和UBE组(P<0.05)。(2)术后3个月UBE组腰痛VAS高于PETD和PEID组(P<0.05);而PETD组与PEID组比较,差异无统计学意义(P>0.05)。末次随访3组腰痛VAS组间比较,差异无统计学意
Objective To compare clinical efficacy and complication rate of percutaneous endoscopic transforaminal discectomy(PETD),percutaneous endoscopic interlaminar discectomy(PEID)and unilateral biportal endoscopic(UBE)in treating single-segment lumbar disc herniation(LDH).Methods From October 2019 to August 2021,121 LDH patients with single-segment treated by spinal endoscopy were retrospectively analyzed and divided into three groups.In PETD group,there were 48 patients,including 19 males and 29 females,aged from 18 to 72 years old with an average of(44.0±13.9)years old;3 patients with L3,4 segments,27 patients with L4,5 segments,and 18 patients with L5S1 segments.In PEID group,there were 43 patients,including 23 males and 20 females,aged from 20 to 69 years old with an average of(40.1±12.1)years old;1 patient with L3,4 segments,15 patients with L4,5 segments,and 27 patients with L5S1 segments.In UBE group,there were 30 patients,including 12 males and 18 females,aged from 29 to 72 years old with an average of(41.2±15.0)years old;1 patient with L3,4 segments,18 patients with L4,5 segments,and 11 patients with L5S1 segments.Operation time,blood loss,fluoroscopy times and complications among three groups were observed and compared.Before opertaion,3 months after operation and at the latest follow-up,visual analogue scale(VAS)was used to evaluate low back pain and lower extremity pain,Oswestry disfunction index(ODI)was used to evaluate lumbar function,and modified MacNab was used to evaluate clinical efficacy at the latest follow-up.Results All patients were performed endoscopic spinal surgery completly and were followed up for at least 12 months.One patient occurred dural sac rupture both in PETD and PEID group,and dural sac rupture was small,and there was no obvious discomfort after operation.Two patients were occurred intraoperative rupture of dural sac in UBE group.One patient was occurred cerebrospinal fluid leakage after operation,and was improved after rest in supine position and fluid rehydration.One patient wi
作者
陈康
杨富国
罗园超
何仁建
CHEN Kang;YANG Fu-guo;LUO Yuan-chao;HE Ren-jian(Department of Orthopaedics,the First People's Hospital of Zigong,Zigong 643000,Sichuan,China)
出处
《中国骨伤》
CAS
CSCD
2024年第3期228-234,共7页
China Journal of Orthopaedics and Traumatology
关键词
腰椎间盘突出症
内镜手术
并发症
Lumbar disc herniation
Endoscopic surgery
Complication
