靶向破黄法在单侧双通道脊柱内镜技术治疗腰椎间盘突出症中的临床疗效

韩康; 谭树森; 张政; 张红侠; 米娜; 宋若先

doi:10.16766/j.cnki.issn.1674-4152.002930

靶向破黄法在单侧双通道脊柱内镜技术治疗腰椎间盘突出症中的临床疗效

doi: 10.16766/j.cnki.issn.1674-4152.002930

中国人民解放军联勤保障部队第九六〇医院骨科，山东济南 250000

基金项目:

国家自然科学基金项目 81702935

详细信息

通讯作者:
宋若先，E-mail：gan_7758525@163.com

中图分类号: R681.53 R616.5
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- 文章访问数: 335
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- 被引次数: 0
出版历程
- 收稿日期: 2022-09-11
- 网络出版日期: 2023-05-31

Clinical analysis of targeted broken ligamentum flavum method of unilateral biportal endoscopy in the treatment of lumbar spinal stenosis

Deprtment of Orthopedic, the 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong 250000, China

摘要

摘要: 目的探讨在单侧双通道脊柱内镜技术治疗腰椎间盘突出症中使用靶向破黄法的临床疗效及其安全性。方法回顾性分析2020年1月-2022年1月中国人民解放军联勤保障部队第九六〇医院收治的86例腰椎间盘突出患者。按手术方式分成2组, 靶向破黄法组(TBM组)39例, 常规掀盖法组(CCM组)47例。使用视觉模拟评分法(VAS), 功能障碍指数评分(ODI)及日本骨科协会评估(JOA)评分对疼痛、功能指标及相关并发症进行整理和统计。结果 TBM组手术时间、术中出血、切口长度分别为(58.6±14.5) min、(42.6±10.6) mL及(2.93±0.23) cm, 而CCM组分别为(81.4±17.6) min、(63.8±18.6) mL及(3.12±0.43) cm, 2组比较差异均有统计学意义(均P < 0.001)。而2组住院时间比较差异无统计学意义(P=0.293)。2组术前疼痛及功能指标(VAS、ODI、JOA)差异无统计学意义(均P>0.05);术后2组组间比较差异无统计学意义(均P>0.05), 组内不同时点间差异有统计学意义(均P < 0.05)。2组患者在术后的各项评分较术前有显著改善(均P < 0.05)。所有患者均未出现严重并发症且短期并发症比较差异无统计学意义(P>0.05)。结论靶向破黄法在单侧双通道脊柱内镜技术治疗腰椎间盘突出症的治疗中是一种理想的治疗方式, 在临床中可进一步地进行推广。
- 单侧双通道脊柱内镜技术 /
- 腰椎间盘突出症 /
- 脊柱内镜
Abstract: Objective To observe the clinical efficacy and safety of targeted broken ligamentum flavum method of unilateral biportal endoscopy in the treatment of lumbar spinal stenosis. Methods A total of 86 patients with lumbar disc herniation admitted to the 960th Hospital of the PLA Joint Logistics Support Force from January 2020 to January 2022 were retrospectively analysed.Patients were divided into 2 groups based on the surgery they had undergone: the targeted broken ligamentum flavum method group (TBM group, 39 cases) and the conventional clamshell method group (CCM group, 47 cases).Using visual analogue scale (VAS), oswestry disability index (ODI) and Japanese orthopaedic association (JOA) scores to assess the pain and functional parameters to record surgical complications. Results The mean operating time and bleeding volume were (58.6±14.5) min and (42.6±10.6) mL and the length of the incision was (2.93±0.23) cm in the TBM group, and (81.4±17.6) min and (63.8±18.6) mL and (3.12±0.43) cm in the CCM group, respectively, with statistically significant differences between the 2 groups (all P < 0.001).In contrast, there was no significant difference in the hospital stay time between the 2 groups (P=0.293).No significant differences were observed between the 2 groups in preoperative indices (VAS, ODI, JOA), all P>0.05;no statistically significant differences were observed between the 2 groups postoperatively (all P>0.05).There were significant differences between the 2 groups at different time points after surgery (all P < 0.05).Patients in both groups showed a significant improvement in their postoperative scores compared to their preoperative scores (all P < 0.05).There were no serious complications and there were no significant differences in the short-term between the 2 groups (P>0.05). Conclusion The targeted broken ligamentum flavum method of unilateral biportal endoscopy could be a kind of ideal treatment for lumbar spinal stenosis, which could be further promoted in the clinical practice.
- Unilateral biportal endoscopy /
- Lumbar disc herniation /
- Spinal endoscopye

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图 1 UBE治疗L₅/S₁腰椎间盘突出症典型病例

注：患者男性，31岁，L₅/S₁椎间盘突出。A~D为术前影像学资料。E为术前定位。F为术中透视定位。G~H为术中神经根及纤维环缝合后图像。I为摘除的突出髓核。G为手术结束后完整外观，显示大部分黄韧带及骨质给予保留。K~L为术前及术后骨质3D影像。

Figure 1. Typical cases of L5/S1 lumbar disc herniation treated with UBE

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表 1 2组腰椎间盘突出症患者疼痛指标比较(x±s，分)

Table 1. Comparison of pain index between two groups of patients with lumbar disc herniation (x±s, points)

组别	例数	术前	术后3 d	术后1个月	术后3个月	F值	P值
TBM组	39	8.05±0.95	2.28±0.51^a	1.49±0.51^ab	1.13±0.41^abc	1 249.527	< 0.001
CCM组	47	8.13±1.08	2.25±0.44^a	1.47±0.62^ab	1.13±0.45^abc	0.069	0.977
t值		0.346	0.261	0.154	0.006
P值		0.730	0.795	0.878	0.995
注：与术前比较，^aP < 0.05；与术后3 d比较，^bP < 0.05；与术后1个月比较，^cP < 0.05。

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表 2 2组腰椎间盘突出症患者ODI指标比较(x±s)

Table 2. Comparison of ODI index between two groups of patients with lumbar disc herniation(x±s)

组别	例数	术前	术后3 d	术后1个月	术后3个月	F值	P值
TBM组	39	42.18±11.33	18.92±5.72^a	10.92±2.13^ab	8.21±2.22^abc	220.890	< 0.001
CCM组	47	43.77±12.80	17.60±4.47^a	10.36±2.13^ab	8.32±2.40^abc	0.851	0.470
t值		0.603	1.205	1.216	-0.227
P值		0.548	0.231	0.227	0.821
注：与术前比较，^aP < 0.05；与术后3 d比较，^bP < 0.05；与术后1个月比较，^cP < 0.05。

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表 3 2组腰椎间盘突出症患者JOA指标比较(x±s)

Table 3. Comparison of JOA index in two groups of patients with lumbar disc herniation(x±s)

组别	例数	术前	术后3 d	术后1个月	术后3个月	F值	P值
TBM组	39	8.87±1.73	15.85±2.85^a	16.92±3.49^ab	21.15±4.55^abc	267.414	< 0.001
CCM组	47	8.66±1.39	14.85±3.13^a	17.44±3.89^ab	22.00±4.52^abc	1.367	0.259
t值		0.630	1.528	-0.651	-0.862
P值		0.530	0.130	0.517	0.391
注：与术前比较，^aP < 0.05；与术后3 d比较，^bP < 0.05；与术后1个月比较，^cP < 0.05。

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表 4 2组腰椎间盘突出症患者各手术指标的比较(x±s)

Table 4. Comparison of surgical index between two groups of patients with lumbar disc herniation(x±s)

组别	例数	手术时间 (min)	出血量 (mL)	切口长度 (mm)	住院时间 (d)	引流量 (mL)
TBM组	39	59.2±14.2	42.2±8.4	2.93±0.23	6.62±2.11	20.95±8.81
CCM组	47	78.8±19.3	68.0±17.2	3.12±0.43	7.11±2.17	40.51±9.68
t值		5.271	8.558	2.444	1.058	9.711
P值		< 0.001	< 0.001	0.017	0.293	< 0.001

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