单侧双通道内镜下椎间盘切除术治疗钙化型腰椎间盘突出症的临床疗效分析

Analysis of the clinical efficacy of lumbar disc resection under unilateral biportal endoscopy for calcified lumbar disc herniation

摘要:

目的 观察单侧双通道内镜（UBE）下椎间盘切除术治疗钙化型腰椎间盘突出症（CLDH）的临床疗效。方法 回顾性分析2020年1月－2022年1月在该院行UBE下腰椎间盘切除术的25例单节段CLDH患者的临床资料。记录手术时间、术后住院时间和术后并发症情况。采用腰腿痛视觉模拟评分法（VAS）评分、腰椎日本骨科协会（JOA）评分和Oswestry功能障碍指数（ODI），评估术前、术后3 d、术后1个月和末次随访的临床疗效。末次随访时，采用改良Macnab标准，评估优良率。结果 术后随访12～24个月，平均（15.60±2.60）个月。手术时间为（58.67±10.73）min，术后住院时间为（4.65±0.63）d。术后3 d、术后1个月和末次随访时的VAS评分和ODI明显低于术前，JOA评分明显高于术前，差异均有统计学意义（P < 0.05）。末次随访时，根据改良的Macnab标准，15例为优，9例为良，1例为可，优良率为96.00%（24/25）。术后并发症：1例神经根腹侧硬膜囊撕裂，长度约5 mm，未行硬膜囊修补术，术后嘱患者卧床5 d，给予补液治疗，患者下床活动未诉头痛等不适，术后MRI显示：未见硬膜外大量积液；1例出现下肢感觉障碍，给予营养神经药物对症治疗，术后1个月随访时恢复。术后影像学检查显示：游离钙化组织基本被完全切除，神经根得到充分减压。末次随访时，未发现复发病例。结论 UBE下腰椎间盘切除术治疗CLDH安全、有效，值得应用于临床。

Abstract:

Objective To observe the clinical efficacy of lumbar disc resection under unilateral biportal endoscopy (UBE) for calcified lumbar disc herniation (CLDH).Methods A retrospective analysis was conducted on 25 patients with single-segment CLDH who underwent lumbar disc resection under UBE from January 2020 to January 2022. The operation time, postoperative hospital stay, and postoperative complications were recorded. The visual analogue scale (VAS) score for low back and leg pain, Japanese Orthopaedic Association (JOA) score for the lumbar spine, and Oswestry disability index (ODI) were used to evaluate the efficacy before surgery, 3 d after surgery, 1 month after surgery, and at the last follow-up. At the last follow-up, the modified Macnab standard was used to assess the excellent and good rate.Results The patients were followed up for 12 ~ 24 months, with an average of (15.60 ± 2.60) months. The average operation time was (58.67 ± 10.73) min, and the postoperative hospital stay was (4.65 ± 0.63) d. The VAS score, and ODI were lower, and JOA score was higher at 3 d after surgery, 1 month after surgery, and the last follow-up compared with those before surgery, and the differences were statistically significant (P < 0.05). At the last follow-up, according to the modified Macnab criteria, 15 cases were rated as excellent, 9 cases as good, and 1 case as fair. The excellent and good rate was 96.00% (24/25). Postoperative complications included a tear of the ventral dural sac of the nerve root, about 5 mm in length, without dural sac repair. The patient was instructed to stay in bed for 5 d after surgery and was given fluid replacement. The patient did not complain of discomfort such as headache when he got out of bed, and the postoperative MRI showed no massive epidural effusion. One patient had lower limb sensory disturbance and was treated with neurotrophic drugs, and recovered at the 1-month follow-up after surgery. Postoperative imaging examinations showed that the free calcified tissues were basically completely resected and the nerve roots were adequately decompressed. At the last follow-up, no recurrent cases were found.Conclusion Lumbar disc resection under UBE for CLDH is an effective and safe minimally invasive technique.