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[1]位新維,喻景奕.經(jīng)皮單通道與經(jīng)皮單側(cè)雙通道脊柱內(nèi)鏡下髓核摘除術(shù)治療腰椎間盤突出癥的比較研究[J].中醫(yī)正骨,2022,34(05):21-27.
　WEI Xinwei,YU Jingyi.A comparative study of percutaneous endoscopic spinal discectomy through uniportal versus unilateral biportal for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(05):21-27.
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經(jīng)皮單通道與經(jīng)皮單側(cè)雙通道脊柱內(nèi)鏡下髓核摘除術(shù)治療腰椎間盤突出癥的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年05期
頁碼:
21-27
欄目:
臨床研究
出版日期:
2022-05-20

文章信息/Info

Title:
A comparative study of percutaneous endoscopic spinal discectomy through uniportal versus unilateral biportal for treatment of lumbar disc herniation
作者:
位新維; 喻景奕
(周口市中心醫(yī)院,河南 周口 466000)
Author(s):
WEI Xinwei; YU Jingyi
Zhoukou Central Hospital,Zhoukou 466000,Henan,China
關(guān)鍵詞:
腰椎;  椎間盤移位;  椎間盤切除術(shù); 經(jīng)皮;  內(nèi)窺鏡;  臨床試驗(yàn)
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  diskectomy; percutaneous;  endoscopes;  clinical trial
摘要:
目的:比較經(jīng)皮單通道與經(jīng)皮單側(cè)雙通道脊柱內(nèi)鏡下髓核摘除術(shù)治療腰椎間盤突出癥的臨床療效。方法:選取2018年6月至2020年4月在周口市中心醫(yī)院住院治療的腰椎間盤突出癥患者為研究對象。采用隨機(jī)數(shù)字表將符合要求的患者隨機(jī)分為單通道組和單側(cè)雙通道組。2組均采用經(jīng)皮脊柱內(nèi)鏡下髓核摘除術(shù)治療,其中單通道組采用經(jīng)皮單通道技術(shù)、單側(cè)雙通道組采用經(jīng)皮單側(cè)雙通道技術(shù)。觀察記錄患者的切口長度、手術(shù)時間。采用疼痛視覺模擬量表(visual analogue scale,VAS)評分評價腰部疼痛情況,采用Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評價腰椎功能。術(shù)后6個月,采用日本骨科協(xié)會(Japanese Orthopaedic Association,JOA)腰痛疾患療效評分標(biāo)準(zhǔn)評價綜合療效。結(jié)果:共納入60例患者,單通道組和單側(cè)雙通道組各30例。①一般指標(biāo)。單通道組的切口長度和手術(shù)時間均短于單側(cè)雙通道組[(0.77±0.18)cm,(1.52±0.59)cm,t=2.583,P=0.012;(43.57±9.42)min,(50.64±10.66)min,t=2.156,P=0.035]。②腰部疼痛VAS評分。時間因素與分組因素不存在交互效應(yīng)(F=2.380,P=0.119)。2組患者腰部疼痛VAS評分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=17.195,P=0.000)。手術(shù)前后不同時間點(diǎn)腰部疼痛VAS評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時間效應(yīng)(F=1 352.911,P=0.000)。2組患者的腰部疼痛VAS評分隨時間變化均呈下降趨勢,但2組的下降趨勢不完全一致(F=1 058.132,P=0.000; F=447.262,P=0.000)。術(shù)前、術(shù)后6個月,2組患者腰部疼痛VAS評分的組間差異均無統(tǒng)計(jì)學(xué)意義[(8.19±1.07)分,(8.45±1.59)分,t=0.647,P=0.428;(0.59±0.10)分,(0.61±0.18)分,t=0.289,P=0.595]。術(shù)后1 d、3個月,單通道組腰部疼痛VAS評分均低于單側(cè)雙通道組[(3.24±0.27)分,(4.03±0.56)分,t=62.087,P=0.000;(1.04±0.32)分,(1.43±0.76)分,t=6.174,P=0.019]。③ODI。術(shù)前、術(shù)后6個月,2組患者ODI比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(45.32±11.67)%,(44.67±10.59)%,t=0.589,P=0.558;(2.81±0.87)%,(3.05±1.03)%,t=1.256,P=0.214]。術(shù)后6個月,2組患者ODI均較術(shù)前降低(t=22.561,P=0.000; t=23.478,P=0.000)。④JOA評分。術(shù)前、術(shù)后6個月,2組患者JOA評分比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(8.69±2.53)分,(9.07±1.97)分,t=0.789,P=0.433;(27.98±3.21)分,(28.14±4.05)分,t=1.274,P=0.208]。術(shù)后6個月,2組患者JOA評分均較術(shù)前增高(t=25.698,P=0.000; t=25.017,P=0.000)。⑤綜合療效。術(shù)后6個月,單通道組優(yōu)16例、良11例、可3例,單側(cè)雙通道組優(yōu)15例、良10例、可5例。2組患者的綜合療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=-0.450,P=0.653)。結(jié)論:經(jīng)皮單通道與經(jīng)皮單側(cè)雙通道脊柱內(nèi)鏡下髓核摘除術(shù)治療腰椎間盤突出癥,二者的療效相當(dāng),但后者的切口和手術(shù)時間相對較長。
Abstract:
Objective:To compare the clinical outcomes of percutaneous endoscopic spinal discectomy through uniportal versus unilateral biportal for treatment of lumbar disc herniation(LDH).Methods:The LDH patients who were treated in Zhoukou Central Hospital from June 2018 to April 2020 were selected as the subjects.Sixty patients were enrolled in the study,and were randomly divided into uniportal group and unilateral biportal group by using random digits table,30 cases in each group.All patients in the 2 groups were treated with percutaneous endoscopic spinal discectomy.The patients in uniportal group were treated through uniportal,and the ones in unilateral biportal group through unilateral biportal.The incision length and operative time were observed and recorded.The low back pain and lumbar function were evaluated by using pain visual analogue scale(VAS)score and Oswestry disability index(ODI)respectively,and the total clinical outcomes were evaluated by using Japanese Orthopaedic Association(JOA)therapeutic effect rating standards for low back pain on month 6 after the surgery.Results:①The incision length and operative time were shorter in uniportal group compared to unilateral biportal group(0.77±0.18 vs 1.52±0.59 cm,t=2.583,P=0.012; 43.57±9.42 vs 50.64±10.66 minutes,t=2.156,P=0.035).②There was no interaction between time factor and group factor in low back pain VAS score(F=2.380,P=0.119).There was statistical difference in the low back pain VAS scores between the 2 groups in general,in other words,there was group effect(F=17.195,P=0.000).There was statistical difference in low back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=1 352.911,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(F=1 058.132,P=0.000; F=447.262,P=0.000).There was no statistical difference in low back pain VAS scores between the 2 groups before the surgery and on month 6 after the surgery(8.19±1.07 vs 8.45±1.59 points,t=0.647,P=0.428; 0.59±0.10 vs 0.61±0.18 points,t=0.289,P=0.595).The low back pain VAS scores were lower in uniportal group compared to unilateral biportal group on day 1 and month 3 after the surgery(3.24±0.27 vs 4.03±0.56 points,t=62.087,P=0.000; 1.04±0.32 vs 1.43±0.76 points,t=6.174,P=0.019).③There was no statistical difference in ODI between the 2 groups before the surgery and on month 6 after the surgery(45.32±11.67 vs 44.67±10.59%,t=0.589,P=0.558; 2.81±0.87 vs 3.05±1.03%,t=1.256,P=0.214).The ODI decreased in the 2 groups on month 6 after the surgery compared to pre-surgery(t=22.561,P=0.000; t=23.478,P=0.000).④There was no statistical difference in JOA scores between the 2 groups before the surgery and on month 6 after the surgery(8.69±2.53 vs 9.07±1.97 points,t=0.789,P=0.433; 27.98±3.21 vs 28.14±4.05 points,t=1.274,P=0.208).The JOA score increased in the 2 groups on month 6 after the surgery compared to pre-surgery(t=25.698,P=0.000; t=25.017,P=0.000).⑤The total clinical outcomes were evaluated on month 6 after the surgery.Sixteen patients obtained an excellent result,11 good and 3 fair in uniportal group; while 15 ones obtained an excellent result,10 good and 5 fair in unilateral biportal group.There was no statistical differences in the total clinical outcomes between the 2 groups(Z=-0.450,P=0.653).Conclusion:Percutaneous endoscopic spinal discectomy through uniportal is similar to percutaneous endoscopic spinal discectomy through unilateral biportal in the clinical outcomes in treatment of LDH,while the former displays the advantages of shorter incision length and operative time compared to the latter.

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(收稿日期:2021-01-28 本文編輯:郭毅曼)

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通訊作者:位新維 E-mail:[email protected]
更新日期/Last Update: 1900-01-01