单通道经椎间孔镜下椎间盘切除术与单侧双通道内镜下椎间盘切除术治疗单节段腰椎间盘突出症的临床比较

Clinical Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Unilateral Biportal Endoscopic Discectomy for Single-Level Lumbar Disc herniation

摘要: 目的：比较单通道经椎间孔镜下椎间盘切除术(PTED)和单侧双通道内镜下椎间盘切除术(UBE)治疗单节段腰椎间盘突出症(LDH)的临床效果。材料与方法：回顾性分析了2020年1月至2021年11月期间62例单节段LDH患者的临床资料。所有患者均在我院和温州医科大学附属第一医院接受了脊柱手术。其中30例患者接受了UBE治疗，32例患者接受了PTED治疗。所有患者均随访至少一年。术前和术后回顾患者的人口统计学特征和围手术期结果。使用Oswestry功能障碍指数(ODI)、腰腿痛的视觉模拟评分(VAS)以及改良MacNab标准来评估临床效果。术后一年进行X线检查以评估腰椎的稳定性。结果：UBE组和PTED组的平均年龄分别为46.7岁和48.0岁。与UBE组相比，PTED组术后1天和7天的腰背痛VAS评分更好(3.06 ± 0.80 vs 4.03 ± 0.81, P < 0.05; 2.81 ± 0.60 vs 3.70 ± 0.79, P < 0.05)。UBE组和PTED组在腿痛VAS评分和ODI评分上均有显著改善，并且在末次随访时，两组之间没有显著差异(P > 0.05)。虽然UBE组和PTED组在改良MacNab标准的优良率上相似(86.7% vs 87.5%, P > 0.05)，但PTED在手术时间、估计失血量、切口长度和术后住院时间方面具有优势。结论：UBE和PTED在单节段LDH患者中均有良好的临床效果。然而，PTED在术后短期背痛缓解和围手术期生活质量方面优于UBE。

Abstract: Purpose: To compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBE) for the treatment of single-level lumbar disc herniation (LDH). Materials and Methods: From January 2020 to November 2021, 62 patients with single-level LDH were retrospectively reviewed. All patients underwent spinal surgeries at the Longgang People’s Hospital and the First Affiliated Hospital of Wenzhou Medical University. Among them, 30 patients were treated with UBE, and 32 were treated with PTED. The patients were followed up for at least one year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain and leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. x-ray examinations were performed one year after surgery to assess the stability of the lumbar spine. Results: The mean ages in the UBE and PTED groups were 46.7 years and 48.0 years, respectively. Compared to the UBE group, the PTED group had better VAS scores at 1 and 7 days after surgery (3.06 ± 0.80 vs. 4.03 ± 0.81, P < 0.05; 2.81 ± 0.60 vs. 3.70 ± 0.79, P < 0.05). The UBE and PTED groups demonstrated significant improvements in the VAS score and ODI score, and no significant differences were found between the groups at last follow-up (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the UBE group was similar to that in the PTED group (86.7% vs. 87.5%, P > 0.05), PTED was advantageous in terms of the operation time, estimated blood loss, incision length, and length of postoperative hospital stay. Conclusions: Both UBE and PTED have favorable outcomes in patients with single-level LDH. However, PTED is superior to UBE in terms of short-term postoperative back pain relief and perioperative quality of life.