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[1]李穩(wěn)超,李紅衛(wèi),朱廣曄,等.單側(cè)雙通道內(nèi)鏡下椎間盤(pán)切除術(shù)與經(jīng)皮內(nèi)鏡椎間孔入路椎間盤(pán)切除術(shù)治療鈣化型腰椎間盤(pán)突出癥的對(duì)比研究[J].中醫(yī)正骨,2023,35(10):1-6.
　LI Wenchao,LI Hongwei,ZHU Guangye,et al.A comparative study of unilateral biportal endoscopic discectomy versus percutaneous endoscopic transforaminal discectomy for treatment of calcified lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(10):1-6.
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單側(cè)雙通道內(nèi)鏡下椎間盤(pán)切除術(shù)與經(jīng)皮內(nèi)鏡椎間孔入路椎間盤(pán)切除術(shù)治療鈣化型腰椎間盤(pán)突出癥的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年10期
頁(yè)碼:
1-6
欄目:
臨床研究
出版日期:
2023-10-20

文章信息/Info

Title:
A comparative study of unilateral biportal endoscopic discectomy versus percutaneous endoscopic transforaminal discectomy for treatment of calcified lumbar disc herniation
作者:
李穩(wěn)超; 李紅衛(wèi); 朱廣曄; 周宇; 郭宏; 李亞浩; 姜宏; 俞鵬飛
南京中醫(yī)藥大學(xué)附屬蘇州市中醫(yī)醫(yī)院,江蘇 蘇州 215009
Author(s):
LI Wenchao; LI Hongwei; ZHU Guangye; ZHOU Yu; GUO Hong; LI Yahao; JIANG Hong; YU Pengfei
Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu,China
關(guān)鍵詞:
椎間盤(pán)移位;  腰椎;  椎間盤(pán)切除術(shù);  內(nèi)窺鏡;  臨床試驗(yàn)
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  diskectomy;  endoscopes;  clinical trial
摘要:
目的:比較單側(cè)雙通道內(nèi)鏡(unilateral biportal endoscopy,UBE)下椎間盤(pán)切除術(shù)與經(jīng)皮內(nèi)鏡椎間孔入路椎間盤(pán)切除術(shù)(percutaneous endoscopic transforaminal discectomy,PETD)治療鈣化型腰椎間盤(pán)突出癥的療效和安全性。方法:收集2020年1月至2022年1月收治的60例鈣化型腰椎間盤(pán)突出癥患者的病例資料,其中30例采用UBE下椎間盤(pán)切除術(shù)治療(UBE組)、30例采用PETD治療(PETD組)。比較2組患者的手術(shù)時(shí)間、術(shù)中X線透視次數(shù)、隱性失血量、住院時(shí)間、末次隨訪時(shí)腰痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、末次隨訪時(shí)腿痛VAS評(píng)分、末次隨訪時(shí)Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、基于改良MacNab標(biāo)準(zhǔn)評(píng)定的綜合療效及并發(fā)癥發(fā)生情況。結(jié)果:2組患者隱性失血量、住院時(shí)間、末次隨訪時(shí)腰痛VAS評(píng)分、末次隨訪時(shí)腿痛VAS評(píng)分的組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[隱性失血量:(398.23±155.41)mL,(374.26±155.41)mL,t=-0.642,P=0.523; 住院時(shí)間:(6.00,2.50)d,(6.00,2.00)d,Z=-0.323,P=0.747; 末次隨訪時(shí)腰痛VAS評(píng)分:(1.00,1.00)分,(1.00,1.00)分,Z=-0.248,P=0.804; 末次隨訪時(shí)腿痛VAS評(píng)分:(2.00,1.00)分,(2.00,0.00)分,Z=-0.907,P=0.364]; 與PETD組相比,UBE組的手術(shù)時(shí)間更短、術(shù)中X線透視次數(shù)更少、末次隨訪時(shí)ODI更低[手術(shù)時(shí)間:(66.67±7.34)min,(70.77±5.31)min,t=-2.480,P=0.016; 術(shù)中X線透視次數(shù):(4.00,0.00)次,(9.00,2.25)次,Z=-6.802,P=0.000; 末次隨訪時(shí)ODI:(11.00,3.25)%,(13.25,2.00)%,Z=-4.570,P=0.000]。2組綜合療效的差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-0.108,P=0.914)。UBE組1例術(shù)中發(fā)生硬脊膜撕裂、2例術(shù)后下肢皮膚感覺(jué)障礙加重、2例發(fā)生切口疝,PETD組1例術(shù)中發(fā)生硬脊膜撕裂、3例術(shù)后下肢皮膚感覺(jué)障礙加重,經(jīng)對(duì)癥處理后均順利出院,2組患者并發(fā)癥發(fā)生率的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=1.000)。結(jié)論:應(yīng)用UBE下椎間盤(pán)切除術(shù)與PETD治療鈣化型腰椎間盤(pán)突出癥的療效和安全性相當(dāng),但UBE技術(shù)在減少術(shù)中X線透視次數(shù)、縮短手術(shù)時(shí)間方面具有一定優(yōu)勢(shì)。
Abstract:
Objective:To compare the clinical outcomes and safety of unilateral biportal endoscopic(UBE)discectomy versus percutaneous endoscopic transforaminal discectomy(PETD)in treatment of calcified lumbar disc herniation(CLDH).Methods:The clinical data of 60 patients with CLDH recruited from January 2020 to January 2022 were collected.Thirty patients were treated with UBE discectomy(UBE group)and 30 ones with PETD(PETD group).The operative time,intraoperative X-ray exposure,hidden blood loss,hospital stays,total outcomes evaluated according to the modified Macnab's criterion,and the complications were compared between the 2 groups; besides,the low back pain visual analogue scale(VAS)score,the leg pain VAS score and the Oswestry disability index(ODI)evaluated at the last follow-up were compared between the 2 groups.Results:The difference was not statistically significant in the hidden blood loss,hospital stays,the low back and leg pain VAS scores evaluated at the last follow-up between the 2 groups(hidden blood loss:398.23±155.41 vs 374.26±155.41 mL,t=-0.642,P=0.523; hospital stays:(6.00,2.50)vs(6.00,2.00)days,Z=-0.323,P=0.747; low back pain VAS score evaluated at the last follow-up:(1.00,1.00)vs(1.00,1.00)points,Z=-0.248,P=0.804; leg pain VAS score evaluated at the last follow-up:(2.00,1.00)vs(2.00,0.00)points,Z=-0.907,P=0.364).The UBE group displayed shorter operative time,fewer intraoperative X-ray exposure and lower ODI evaluated at the last follow-up compared to PETD group(operative time:66.67±7.34 vs 70.77±5.31 minutes,t=-2.480,P=0.016; intraoperative X-ray exposure:(4.00,0.00)vs(9.00,2.25)times,Z=-6.802,P=0.000; ODI evaluated at the last follow-up:(11.00,3.25)vs(13.25,2.00)%,Z=-4.570,P=0.000).There was no statistical difference in the total outcomes between the 2 groups(Z=-0.108,P=0.914).The intraoperative dural tears(1 case),postoperative aggravated esthesiodermia in lower extremity(2 cases),and incisional hernia(2 cases)were found in UBE group; while the intraoperative dural tears(1 case),and postoperative aggravated esthesiodermia in lower extremity(3 cases)were found in PETD group.All patients were successfully discharged after symptomatic treatment.There was no statistical difference in complication incidences between the 2 groups(P=1.000).Conclusion:UBE discectomy is similar to PETD in clinical outcomes and safety in treatment of CLDH,while the former has certain advantages over the latter in reducing intraoperative X-ray exposure and shortening operative time.

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備注/Memo

備注/Memo:
基金項(xiàng)目:國(guó)家自然科學(xué)基金項(xiàng)目(82004393); 蘇州市科技發(fā)展計(jì)劃項(xiàng)目(SKY2023066,SYSD2020146); 蘇州市姑蘇衛(wèi)生人才計(jì)劃人才科研項(xiàng)目(GSWS2021049)
通訊作者:俞鵬飛 E-mail:[email protected]
更新日期/Last Update: 1900-01-01