单侧双通道内镜与经皮椎间孔镜技术治疗极外侧型腰椎间盘突出症的临床疗效对比

Clinical efficacy of unilateral biportal endoscopy and percutaneous transforaminal endoscopic discectomy in treating far lateral lumbar disc herniation

摘要:

目的 比较单侧双通道内镜（UBE）与经皮椎间孔镜下髓核摘除术（PTED）治疗极外侧型腰椎间盘突出症（FLLDH）的临床疗效。方法 回顾性分析2021年3月－2023年3月于该院进行治疗的FLLDH患者42例，根据手术方法不同，将患者分为UBE组（18例）和PTED组（24例）。记录并比较两组患者手术时间、术中透视次数、住院时间和围手术期并发症等指标。采用疼痛视觉模拟法（VAS）评估疼痛程度，Oswestry功能障碍指数（ODI）评估功能障碍情况，Macnab评分标准评估临床疗效。结果 UBE组手术时间为（95.56±20.94）min，较PTED组的（78.25±17.23）min长，术中出血量为（69.17±8.95）mL，较PTED组的（23.96±5.89）mL多，差异均有统计学意义（P < 0.05）。UBE组住院时间为（5.67±1.28）d，与PTED组的（5.33±1.05）d比较，差异无统计学意义（P > 0.05）。UBE组术中透视次数为（3.00±0.77）次，明显少于PTED组的（7.42±0.93）次，差异有统计学意义（P < 0.05）。两组患者术后VAS评分和ODI较术前明显降低，差异均有统计学意义（P < 0.05）。术后3 d，UBE组腿痛VAS评分为（3.28±0.58）分及ODI为（41.17±4.30）%，明显低于PTED组的（4.13±0.74）分及（45.50±3.91）%，差异均有统计学意义（P < 0.05），但两组患者术后3个月和1年的VAS评分及ODI比较，差异均无统计学意义（P > 0.05）。两组患者优良率比较，差异无统计学意义（88.9%和87.5%，P = 0.563）。PTED组围手术期出现神经损伤2例，UBE组无神经损伤出现，两组均无感染、复发和大出血等严重并发症发生。结论 PTED与UBE两种手术方式治疗FLLDH均安全和有效。但UBE术中透视次数少，镜下视野更加清晰，神经损伤风险更小。

Abstract:

Objective To compare the clinical efficacy of unilateral biportal endoscopy (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) in treatment of far lateral lumbar disc herniation (FLLDH).Method A retrospective analysis was conducted on 42 patients with FLLDH who underwent surgery from March 2021 to March 2023. The UBE group included 18 patients, and the PTED group included 24 patients. The surgery duration, intraoperative fluoroscopy times, length of hospital stay, perioperative complications were recorded and compared between the two groups. The degree of pain was evaluated by visual analogue scale (VAS) score for pain, the Oswestry disability index (ODI) for dysfunction was used, and the Macnab scoring standard was used to evaluate the clinical efficacy.Result The operation time of the UBE group was (95.56 ± 20.94) min, which was longer than that of the PTED group (78.25 ± 17.23) min, and the intraoperative blood loss was (69.17 ± 8.95) mL, which was more than that of the PTED group (23.96 ± 5.89) mL, the differences were statistically significant (P < 0.05). The hospitalization time of the UBE group was (5.67 ± 1.28) d, compared with that of the PTED group (5.33 ± 1.05) d, the difference was not statistically significant (P > 0.05). The intraoperative fluoroscopy times in the UBE group was (3.00 ± 0.77) times, which was significantly less than that in the PTED group (7.42 ± 0.93) times, and the difference was statistically significant (P < 0.05). The VAS score and ODI of the two groups of patients after the operation were significantly lower than those before the operation, and the differences were statistically significant (P < 0.05). Three days after the operation, the VAS score of leg pain in the UBE group was (3.28 ± 0.58) and ODI was (41.17 ± 4.30)%, which were significantly lower than those in the PTED group (4.13 ± 0.74) and (45.50 ± 3.91)%, and the differences were statistically significant (P < 0.05). However, when comparing the VAS score and ODI of the two groups 3 months and one year after the operation, the differences were not statistically significant (P > 0.05). There was no statistically significant difference in the excellent and good rate between the two groups of patients (88.9% vs 87.5%, P = 0.563). Two cases of nerve injury occurred in the PTED group, while no nerve injury was reported in the UBE group. No infections, recurrences, or major bleeding complications occurred in either group.Conclusion Both PTED and UBE are safe and effective for treatment of FLLDH. There is less intraoperative fluoroscopy time, clearer endoscopic view, and significantly lower risk of nerve injury in UBE.