单侧双通道内镜椎旁入路治疗极外侧型腰椎间盘突出症的临床疗效

Clinical curative effect of unilateral biportal endoscopy with paravertebral approach in treatment of extreme lateral lumbar disc herniation

摘要:

目的 观察单侧双通道内镜（UBE）技术治疗极外侧型腰椎间盘突出症（ELLDH）的临床疗效。方法 选取2019年6月－2022年6月该院因极外侧型椎间盘突出行UBE下椎间盘髓核摘除术治疗的患者25例。其中，男16例，女9例；年龄26～62岁，平均（53.67±17.45）岁。病史3 d～10年。椎间孔内型（I型）9例，椎间孔外型（Ⅱ型）13例，混合型（Ⅲ型）3例。L_4/5间隙8例，L₅/S₁间隙17例。所有患者术前均行腰椎正侧位X线、CT和MRI检查。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）分别对手术前、术后第3天和术后３个月下肢、腰部疼痛和机体功能恢复情况进行评估，采用Macnab标准对近期手术疗效进行评价。结果 UBE技术治疗ELLDH，手术时间（79.79±23.97）min，术中出血量为40～80 mL，平均（55.80±10.74）mL。随访时间（7.02±4.26）个月。术前，下肢VAS为（7.04±0.92）分，腰部VAS为（3.49±1.52）分，ODI为（35.03±2.97）%，术后第3天，下肢VAS为（2.17±0.61）分，腰部VAS为（1.48±0.43）分，ODI为（18.77±3.15）%，术后3个月，下肢VAS为（1.38±0.65）分，腰部VAS为（1.03±0.48）分，ODI为（6.05±1.80）%，术后第3天和3个月较术前明显降低，差异均有统计学意义（P < 0.05）。优良率为96.0%（优20例，良4例，可1例），随访期间未发生并发症。结论 UBE技术治疗ELLDH，疗效好，创伤小，术中视野开阔、清晰，患者体验佳，安全性高。值得临床推广应用。

Abstract:

Objective To observe the clinical curative effect of unilateral biportal endoscopy (UBE) in the treatment of extreme lateral lumbar disc herniation (ELLDH).Methods From June 2019 to June 2022, 25 patients with ELLDH were treated with UBE-guided discectomy, including 16 males and 9 females. The age ranged from 26 to 62 years with a mean of (53.67 ± 17.45) years. History ranged from 3 d to 10 years. There were 9 cases of internal foraminal type (type I), 13 cases of external foraminal type (type II) and 3 case of mixed type (type III). There were 8 cases of L_4/5 space and 17 cases of L₅/S₁ space. All the patients underwent anterior and lateral lumbar X-rays, CT and MRI scans before surgery. The visual analogue scale (VAS) pain score and Oswestry disability index (ODI) assessed lower limb and lower back pain and functional recovery before surgery and at 3 d and 3 months after surgery, respectively. Macnab criteria evaluated the immediate surgical outcome.Results The UBE technique was used to treat ELLDH. The operative time was (79.79 ± 23.97) min, the intraoperative bleeding volume was 40 ~ 80 mL, with an average of (55.80±10.74) mL. Follow-up time was (7.02 ± 4.26) months. Preoperative VAS of lower limb was (7.04 ± 0.92), lower back VAS was (3.49 ± 1.52), ODI was (35.03 ± 2.97)%. Compared with the preoperative results, the lower limb VAS was (2.17 ± 0.61), lower back VAS was (1.48 ± 0.43), and ODI was (18.77±3.15)% on day 3 after surgery, lower limb VAS was (1.38 ± 0.65), lower back VAS was (1.03 ± 0.48) and ODI was (6.05 ± 1.80)% on the 3 months after surgery were improved (P < 0.05). The excellent and good rate was 96.0% (excellent 20, good 4, fair 1), and no obvious complications were observed during the follow-up.Conclusion UBE is effective, with little trauma, clear intraoperative visual field, good intraoperative experience, and less traumatic and safe in the treatment of ELLDH.