| 单侧双通道内镜技术治疗腰椎间盘突出症的疗效及去骨量分析 |
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Received:January 31, 2023
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| 作者 | Author | 单位 | Unit | E-Mail |
| 莘清云 |
XIN Qing-yun |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 李文正 |
LI Wen-zheng |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 韩钧鉴 |
HAN Jun-jian |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 刘启涛 |
LIU Qi-tao |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 冯超 |
FENG Chao |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 郭秀生 |
GUO Xiu-sheng |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 魏杰 |
WEI Jie |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 宋洁富 |
SONG Jie-fu |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 秦德安 |
QIN De-an |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
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| 张登君 |
ZHANG Deng-jun |
山西医科大学第五临床医学院 山西省人民医院骨科, 山西 太原 030029 |
Department of Orthopaedics, the Fifth Clinical Medical College of Shanxi Medical University, Shanxi Provincial People's Hospital, Shanxi 030029, Taiyuan, China |
robustalps@163.com |
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| 期刊信息：《中国骨伤》2024年37卷，第3期，第222-227页 |
| DOI：10.12200/j.issn.1003-0034.20221038 |
| 基金项目:山西省基础研究计划项目(编号:20210302123349) |
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目的:比较单侧双通道内镜(unilateral biportal endoscopic,UBE)和椎板小开窗术式治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效及骨去除量。
方法:回顾性分析2019年12月至2021年12月收治的105例单节段LDH患者,其中54例接受UBE治疗(UBE组),男32例,女22例,年龄18~50 (38.7±9.3)岁; L4-5 29例,L5S1 25例。51例接受椎板小开窗术式治疗(椎板小开窗组),男27例,女24例,年龄18~50(39.9±10.0)岁;L4,5 25例,L5S1 26例。观察并比较两组手术时间、术后下床时间、住院时间等围手术期指标,分别于术前和术后1、3、6、12个月比较两组腰腿痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI),并采用改良MacNab标准进行临床疗效评价。比较两组下关节突椎板复合体骨去除量和保留率。
结果:105例患者均顺利完成手术。两组均获得随访,时间6~12(10.69±2.49)个月。UBE组手术时间、术后下床时间、住院时间分别为(58.20±5.54) min、(2.40±0.57) d、(3.80±0.61) d,椎板小开窗组分别为(62.90±7.14) min、(4.40±0.64) d、(4.40±0.64) d,两组比较,差异有统计学意义(P<0.05)。两组术后腰痛、腿痛VAS、ODI均较术前明显降低(P<0.05)。UBE组术后1个月腰痛VAS(1.37±0.49)分低于椎板小开窗组(2.45±0.64)分(t=9.745,P<0.05)。UBE组术后1、3个月ODI分别为(28.54±3.31)%、(22.87±3.23)%,均低于椎板小开窗组(36.31±9.08)%、(29.90±8.36)%,差异有统计学意义 (P<0.05)。其他时间点两组腰腿痛VAS、ODI比较,差异无统计学意义(P>0.05)。末次随访时根据改良MacNab标准,UBE组优49例,良3例,可2例;椎板小开窗组中优35例,良12例,可4例,两组比较,差异有统计学意义(χ2=8.321,P<0.05)。UBE组下关节突椎板复合体骨去除量为L4,5节段(0.45±0.08) cm3、L5S1节段(0.31±0.08) cm3;椎板小开窗组L4,5节段(0.57±0.07) cm3、L5S1节段(0.49±0.04) cm3,同一节段UBE组下关节突椎板复合体骨去除量少于椎板小开窗组(P<0.05)。UBE组下关节突椎板复合体保留率为L4,5节段(0.73±0.04)、L5S1节段(0.83±0.03);椎板小开窗组L4,5节段(0.68±0.06),L5S1节段(0.74±0.04),同一节段UBE组下关节突椎板复合体保留率高于椎板小开窗组(P<0.05)。
结论:UBE技术与椎板小开窗术治疗LDH均能达到良好的临床效果,但UBE具有创伤更小、效率更高、术后恢复更快及对骨性结构破坏更小等优势。 |
| [关键词]:单侧双通道 腰椎间盘突出症 微创外科手术 |
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| Clinical outcomes and bone resection analysis of unilateral double-channel endoscopic technique in treating lumbar disc herniation |
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Abstract:
Objective To explore clinical outcomes and bone resection of interlaminar fenestration decompression and unilateral biportal endoscopic (UBE) technique in treating lumbar disc herniation(LDH).
Methods A retrospective study was performed on 105 patients with single-level LDH treated from December 2019 to December 2021. Fifty-four patients in UBE group,including 32 males and 22 females,aged from 18 to 50 years old with an average of(38.7±9.3) years old,were treated with UBE,29 patients with L4,5 and 25 patients with L5S1. There were 51 patients in small fenestration group,including 27 males and 24 females,aged from 18 to 50 years old with an average of (39.9±10.0) years old,were treated with small fenestration,25 patients with L4,5 and 26 patients with L5S1. Perioperative indexes,such as operation time,postoperative time of getting out of bed and hospital stay were observed and compared between two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between two groups before operation and 1,3,6 and 12 months after operation,respectively;and modified MacNab evaluation criteria was used to evaluate clinical efficacy. Amount of bone resection and retention rate of inferior articular process laminoid complex were compared between two groups.
Results All 105 patients were successfully completed operation. Both of two groups were followed up from 6 to 12 months with an average of (10.69±2.49) months. Operation time,postoperative time of getting out of bed and hospital stay were (58.20±5.54) min,(2.40±0.57) d and (3.80±0.61) d in UBE group,and (62.90±7.14) min,(4.40±0.64) d and (4.40±0.64) d in small fenestrum group,respectively;and had statistically difference between two groups(P<0.05). Postoperative VAS of low back and leg pain and ODI in both groups were significantly lower than those before surgery (P<0.05). VAS of lumbar pain in UBE group (1.37±0.49) score was lower than that of small fenestration group (2.45±0.64) score,and had statistically difference (t=9.745,P<0.05). Postoperative ODI in UBE group at 1 and 3 months were (28.54±3.31)% and (22.87±3.23)%,respectively,which were lower than those in small fenestra group (36.31±9.08)% and (29.90±8.36)%,and the difference was statistically significant (P<0.05). There were no significant difference in VAS and ODI between two groups at other time points (P>0.05). According to the modified MacNab evaluation criteria at the latest follow-up,49 patients got excellent result,3 good,and 2 fair in UBE group. In small fenestration group,35 patients got excellent,12 good,and 4 fair. In UBE group,amount of bone resection on L4,5 segment was (0.45±0.08) cm3 and (0.31±0.08) cm3 on the segment of L5S1. In small fenestration group,amount of bone resection on L4,5 segment was (0.57±0.07) cm3 and (0.49±0.04) cm3 on the segment of L5S1,and amount of bone resection of lower articular process laminar complex on the same segment in UBE group was less than that in small fenestration group (P<0.05). In UBE group,retention rate of laminoid complex on L4,5 segment was (0.73±0.04) and L5S1 segment was (0.83±0.03),while L4,5 segment was(0.68±0.06) and L5S1 segment was (0.74±0.04) in small fenestration group,the lower articular process laminar complex retention rate in UBE group was higher than that in small fenestration group(P<0.05).
Conclusion Both unilateral double-channel endoscopy and small fenestration of laminae could achieve good clinical results in treating LDH,but UBE has advantages of less trauma,higher efficiency,faster postoperative recovery and less damage to bone structure. |
| KEYWORDS:Unilateral biportal endoscopic surgery Lumbar disc herniation Minimal surgical procedures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 莘清云,李文正,韩钧鉴,刘启涛,冯超,郭秀生,魏杰,宋洁富,秦德安,张登君.单侧双通道内镜技术治疗腰椎间盘突出症的疗效及去骨量分析[J].中国骨伤,2024,37(3):222~227 |
| 英文格式: | XIN Qing-yun,LI Wen-zheng,HAN Jun-jian,LIU Qi-tao,FENG Chao,GUO Xiu-sheng,WEI Jie,SONG Jie-fu,QIN De-an,ZHANG Deng-jun.Clinical outcomes and bone resection analysis of unilateral double-channel endoscopic technique in treating lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(3):222~227 |
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