| 单侧双通道脊柱内镜靶点技术治疗腰椎间盘突出症的疗效及优势 |
| 投稿时间：2024-12-11 修订日期：2025-01-20 点此下载全文 |
| 引用本文：杜传超,张胜国,吴涛,王翔宇,刘晓光.单侧双通道脊柱内镜靶点技术治疗腰椎间盘突出症的疗效及优势[J].医学研究杂志,2025,54(6):98-102, 108 |
| DOI：
10.11969/j.issn.1673-548X.2025.06.018 |
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| 基金项目:首都卫生发展科研专项(2020-2-4091) |
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| 中文摘要:目的 探究单侧双通道脊柱内镜(unilateral bi-portal spinal endoscopy,UBE)靶点技术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的技术要点及初步疗效。方法 回顾性纳入2022年3月～2023年6月因腰椎间盘突出症由门诊入院行UBE手术治疗的患者,按照手术方法不同分为UBE传统技术组和UBE靶点技术组,UBE传统技术组显露整个椎板间隙,UBE靶点技术组显露部分椎板间隙。记录两组术前及术后第1天、1个月、3个月及6个月的Oswestry功能障碍指数量表(Oswestry disability index,ODI)残障指数、下肢和腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分和术中及术后并发症的发生情况。结果 最终纳入患者78例,UBE传统技术组34例,平均年龄为40.1±12.2岁,男性16例、女性18例；UBE靶点技术组44例,平均年龄为39.7±11.3岁,男性28例、女性16例。UBE传统技术组和UBE靶点技术组基线资料比较,差异无统计学意义,手术均按计划完成,平均手术时间分别为72.03±18.39min、46.2±11.85min,出血量分别为36.3±10.5ml、19.5±5.7ml,差异有统计学意义(P<0.05)。术前1天ODI残障指数及下肢和腰背部VAS评分两组差异无统计学意义。UBE传统技术组术后镇痛药用量高于靶点技术组,术后第1天腰背痛VAS评分及ODI指数均较靶点组升高(P＜0.05),但下肢疼痛两组差异无统计学意义,均得到明显的缓解。术后1个月、3个月、6个月两组腰背部及下肢痛VAS评分比较,差异无统计学意义,但术后1个月、3个月传统技术组ODI较靶点技术组升高。术后6个月靶点技术组改良Macnab优等缓解率为91.5%,UBE传统技术组优等缓解率为89.5%,UBE传统技术组出现脑脊液漏1例,UBE靶点技术组拔管后出现血肿压迫神经症状2例,保守治疗后缓解。结论 UBE靶点技术较UBE传统技术治疗腰椎间盘突出症更具微创优势,有助于术后快速康复。 |
| 中文关键词:单侧双通道脊柱内镜 靶点技术 腰椎管狭窄症手术治疗 |
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| Curative Effect and Superiority Discussion of Unilateral Bi-portal Endoscopic Targeting Technique in the Treatment of Lumbar Disc Herniation. |
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| Abstract:Objective To explore the main points and preliminary efficacy of unilateral bi-portal spinal endoscopy (UBE) in the treatment of lumbar disc herniation(LDH). Methods From March 2022 to June 2023, patients admitted to the spinal surgery department for LDH who underwent UBE surgery were divided into traditional UBE technique group and UBE targeting technique group according to different surgical methods. The traditional UBE technology group revealed the entire interlaminar space, while the targeting technique group revealed part of the interlaminar space. ODI disability index, VAS score of lower extremity and low back, and intraoperative and postoperative complications of the two groups were recorded before operation and at 1day, 1month, 3months and 6months post-operatively. Results A total of 78 patients were included, including 34 patients in the UBE traditional technique group, aged 40.1±12.2 years, 16males and 18 females; 44 patients in the UBE targeting technique group, aged 39.7±11.3 years, 28males and 16 females. There was no significant difference in the basic data between the two groups. The operations were completed as planned. The operation time was 72.03±18.39min vs 46.2±11.85min, and the blood loss was 36.3±10.5ml vs 19.5±5.7ml, respectively. There were no significant differences in ODI disability index, VAS scores of back and lower extremities at 1day before surgery between the two groups. The dosage of postoperative painkillers in the traditional technique group was higher than that in the target technique group, and the VAS score and ODI index of low back pain on the first day after surgery were significantly higher than those in the target group (P<0.05), but there was no significant difference between the two groups of patients with lower extremity pain, both of which were significantly relieved. There was no significant difference in lumbar and lower extremity pain VAS between the two groups at 1month, 3months and 6months after surgery, but ODI in the traditional technique group was significantly higher than that in the targeting technique group at 1month and 3months after surgery. Six months after surgery, the remission rate of modified Macnab criteria in the targeting technique group was 91.5%, and that of the traditional technique group was 89.5% without significant difference(P＞0.05). Cerebrospinal fluid leakage occurred in 1 case in the traditional technique group, and hematoma compression of nerves occurred in 2 cases in the targeting technique group after extubation, which were relieved after conservative treatments. Conclusion UBE targeting technique is more minimally invasive than traditional UBE technique in the treatment of lumbar disc herniation, which is helpful for rapid recovery after surgery. |
| keywords:Unilateral bi-portal spinal endoscopy Targeting technology Lumbar spinal stenosis surgery |
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