单侧双通道脊柱内镜和经皮椎间孔镜下髓核摘除术治疗老年重度脱垂型腰椎间盘突出症的疗效对比 ^*

Comparison of the efficacy of unilateral biplane endoscopy and percutaneous endoscopic lumbar discectomy for nucleotomy in the treatment of severe prolapsed lumbar disc herniation in elderly patients

摘要

目的 探究单侧双通道脊柱内镜 (UBE) 和经皮椎间孔镜下髓核摘除术 (PELD) 治疗老年重度脱垂型腰椎间盘突出症 (LDH) 的临床疗效对比。 方法 选取 2021 年 5 月—2024 年 5 月中国人民解放军联勤保障部队第九○四医院收治的 88 例老年重度脱垂型 LDH 患者作为研究对象。 采用随机数字表法将其分为 UBE 和 PELD 两组, 分别予以 UBE 和 PELD 治疗, 每组 44 例。 对两组患者手术指标及住院时间、 疼痛程度、 并发症、 腰椎功能、 治疗效果以及生活质量进行对比分析。 结果 与 PELD 组比较, UBE 组术中透视次数减少、 手术时间延长、 并发症减少 (P<0.05)。 术后 1、3、6 个月时, 两组患者腰腿部视觉模拟评分法 (VAS) 评分均较术前逐渐下降 (P<0.05); UBE 组术后 VAS 评分均低于 PELD 组 (P<0.05)。 两组临床疗效比较差异无统计学意义 (P>0.05)。 术后 3、6、12 个月时, 两组 Oswestry 功能障碍指数 (ODI) 评分较术前减少, 腰椎日本骨科协会评估治疗分数 (JOA) 评分较术前增加 (P<0.05); UBE 组术后 3、6 个月时 ODI 评分低于 PELD 组, 腰椎 JOA 评分高于 PELD 组 (P<0.05)。 两组术后 SF-36 健康调查量表评分均较术前增加 (P<0.05)。 结论 UBE 和 PELD 下髓核摘除术治疗老年重度脱垂型 LDH 均有一定疗效, 但与 PELD 比较, UBE 能有效减轻疼痛, 促进早期腰椎功能改善。

Abstract

Objective To compare the clinical efficacy of unilateral biplane endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for nucleotomy in the treatment of severe prolapsed lumbar disc herniation (LDH) in elderly patients. Methods A total of 88 elderly patients with severe prolapsed LDH, who were treated at the 904th Hospital of the Joint Logistic Support Force of the People's Liberation Army of China between May 2021 and May 2024, were selected as the study subjects. They were randomly divided into two groups (UBE and PELD) using a random number table method, with 44 patients in each group. The patients in both groups underwent nucleotomy under UBE or PELD, respectively. The surgery-related indicators, hospitalization duration, pain levels, complications, lumbar function, treatment outcomes, and quality of life were compared and analyzed. Results Compared with the PELD group, the UBE group had fewer fluoroscopy instances, longer surgical time, and fewer complications (P<0.05). At 1, 3, and 6 months post-surgery, the Visual analogue scale (VAS) scores for back and leg pain in both groups gradually decreased compared to pre-surgery levels (P<0.05), and the VAS scores in the UBE group were lower than in the PELD group (P<0.05). There was no statistically significant difference in clinical efficacy between the two groups (P>0.05). At 3, 6, and 12 months post-surgery, both groups showed a decrease in Oswestry disability index (ODI) scores and an increase in lumbar Japanese Orthopaedic Association score (JOA) scores compared to pre-surgery (P<0.05). The UBE group had lower ODI scores and higher JOA scores at 3 and 6 months post-surgery compared to the PELD group (P<0.05). Both groups had increased 36-item Short Form Health Survey Questionnaire scores post-surgery compared to pre-surgery (P<0.05). Conclusion Both UBE and PELD nucleotomy are effective in treating elderly patients with severe prolapsed LDH. However, compared to PELD, UBE is more effective in alleviating pain and promoting early lumbar function recovery.

关键词

腰椎间盘突出症 / 重度脱垂型 / 双通道脊柱内镜 / 经皮椎间孔镜下髓核摘除术 / 髓核摘除术

Key words

Lumbar disc herniation / Severe prolapsed type / Unilateral biplane endoscopy / Percutaneous endoscopic lumbar discectomy

参考文献

[1] 王玉, 刘媛媛, 王艳 . 老年腰椎间盘突出症术后并发手术部位感染的影响因素分析[J]. 现代医学, 2025, 53(5): 815-820.

[2] Wang Y , Liu Y Y , Wang Y . Analysis on influencing factors for postoperative infection in elderly patients with lumbar disc herniation[J]. Mod Med J, 2025, 53(5): 815-820.

[3] 徐凯, 杨斐, 祁建华, 等 . 经皮内镜椎板间入路椎间盘切除术治疗重度脱垂型腰椎间盘突出症[J]. 临床骨科杂志, 2022, 25(6): 783-786.

[4] Xu K , Yang F , Qi J H , et al. Percutaneous endoscopic interlaminar discectomy for treatment of severe prolapsus lumbar disc herniation[J]. J Clin Orthop, 2022, 25(6): 783-786.

[5] Zhang Y, Song J, Lin W, et al. Transforaminal endoscopic lumbar discectomy with two—segment foraminoplasty for the treatment of very highly migrated lumbar disc herniation: a retrospective analysis[J]. BMC Surg, 2024, 24(1): 113.

[6] 王彦, 王雨, 高俊, 等 . 单侧双通道内镜技术与显微镜下髓核摘除术治疗老年腰椎间盘突出症的疗效比较[J]. 颈腰痛杂志, 2025, 46(2): 204-211.

[7] Wang Y , Wang Y , Gao J , et al. Comparison of the effect between unilateral biportal endoscopic technique and microscopic lumbar discectomy in the treatment of lumbar disc herniation in the elderly[J]. J Cervicodynia Lumbodynia, 2025, 46(2): 204-211.

[8] 杨海波, 李亚龙, 安帅 . 单侧双通道 UBE 技术与常规 PELD 技术治疗腰椎管狭窄症的疗效比较[J]. 颈腰痛杂志, 2024, 45(3): 471-475.

[9] Yang H B , Li Y L , An S . Comparison of unilateral two channel UBE technique and conventional PELD technique for lumbar spinal stenosis[J]. J Cervicodynia Lumbodynia, 2024, 45(3): 471-475.

[10] Li L, An J, Guo L, et al. Comparison of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH): a retrospective study[J]. J Orthop Surg Res, 2025, 20(1): 510.

[11] 中华医学会骨科学分会骨科康复学组, 中国康复医学会脊柱脊髓专业委员会腰椎研究学组, 王岩, 等 . 老年腰椎间盘突出症诊疗指南[J]. 中华老年骨科与康复电子杂志, 2021, 7(3): 132-139.

[12] Orthopaedic Rehabilitation Group, the Chinese Society for the Study of the Lumbar Spine CSSLS, Wang Y , et al. Guidelines for diagnosis and treatment of lumbar disc herniation in the elderly[J]. Chin J Geriatr Orthop Rehabil Electron Ed, 2021, 7(3): 132-139.

[13] Lee S, Kim S K, Lee S H, et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches[J]. Eur Spine J, 2007, 16(3): 431-437.

[14] Gervais H W . The ASA Classification—solid like a rock in anesthesiology[J]. Anaesthesist, 2017, 66(1): 3-4.

[15] 程继伟, 王振林, 刘伟, 等 . Oswestry 功能障碍指数的改良及信度和效度检验[J]. 中国脊柱脊髓杂志, 2017, 27(3): 235-241.

[16] Cheng J W , Wang Z L , Liu W , et al. Improvement of Oswestry disability index and its test of reliability and validity[J]. Chin J Spine Spinal Cord, 2017, 27(3): 235-241.

[17] 孙兵, 车晓明 . 日本骨科协会评估治疗(JOA 评分)[J]. 中华神经外科杂志, 2013, 29(9): 969.

[18] Sun B , Che X M . Evaluation and treatment of Japanese orthopedic association (JOA score)[J]. Chin J Neurosurg, 2013, 29(9): 969.

[19] 王坤 . 健康状况调查简表(SF—36)[J]. 中华神经外科杂志, 2012(6): 571.

[20] Wang K . Short form of health survey (SF—36)[J]. Chin J Neurosurg, 2012(6): 571.

[21] 宁庆, 李明, 李玉希, 等 . 腰椎间盘纤维环修复的研究进展[J]. 中国脊柱脊髓杂志, 2023, 33(8): 753-759.

[22] Ning Q , Li M , Li Y X , et al. Research progress of lumbar intervertebral disc annulus fibrosus repair[J]. Chin J Spine Spinal Cord, 2023, 33(8): 753-759.

[23] 宰爽嘉, 张亮, 李争光, 等 . 椎间盘细胞的氧化应激损伤在椎间盘退变机制中的研究进展[J]. 实用骨科杂志, 2024, 30(7): 621-626.

[24] Zai S J , Zhang L , Li Z G , et al. Research progress of oxidative stress injury of intervertebral disc cells in the mechanism of intervertebral disc degeneration[J]. J Pract Orthop, 2024, 30(7): 621-626.

[25] Cheng Z, Gan W, Xiang Q, et al. Impaired degradation of PLCG1 by chaperone—mediated autophagy promotes cellular senescence and intervertebral disc degeneration[J]. Autophagy, 2025, 21(2): 352-373.

[26] 孟花, 朱建周, 革军, 等 . 中药熏蒸疼痛干预结合路径式康复措施对微创治疗腰椎间盘突出症术后患者 VAS 评分与康复效果的影响[J]. 临床误诊误治, 2024, 37(10): 63-66.

[27] Meng H , Zhu J Z , Ge J , et al. Impact of traditional Chinese medicine fumigation and pain intervention combined with path—based rehabilitation measures on VAS score and rehabilitation effect of patients with lumbar disc herniation after minimally invasive treatment[J]. Clin Misdiagnosis Mistherapy, 2024, 37(10): 63-66.

[28] Zhang L, Ma T, Xue X, et al. Percutaneous endoscopic lumbar discectomy for highly migrated lumbar—disc herniation via a translaminar keyhole approach: a case report[J]. Asian J Surg, 2024, 47(9): 4213-4214.

[29] 刘海润, 李中实 . 经皮椎间孔镜下椎间盘摘除术治疗脱垂型腰椎间盘突出症的疗效及经验总结[J]. 颈腰痛杂志, 2023, 44(5): 877—878, 882.

[30] Liu H R , Li Z S . Percutaneous intervertebral discectomy under intervertebral foramenmirror for prolapse of lumbar intervertebral disc and its experience[J]. J Cervicodynia Lumbodynia, 2023, 44(5): 877—878, 882.

[31] 刘金龙, 王成虎, 孟庆存 . 单侧双通道脊柱内镜治疗重度脱垂型腰椎间盘突出症[J]. 实用骨科杂志, 2025, 31(5): 385—388, 403.

[32] Liu J L , Wang C H , Meng Q C . Clinical efficacy of unilateral biportal eodoscopy discectomy for treament of far migrated lumbar disc herniation[J]. J Pract Orthop, 2025, 31(5): 385—388, 403.

[33] Hwang J S, Lee S H, Jeong D, et al. Far—lateral transforaminal unilateral biportal endoscopic lumbar discectomy for upper lumbar disc herniations[J]. Neurospine, 2025, 22(1): 14-27.

[34] 曹臣, 陈书连, 高延征, 等 . 单侧双通道内镜治疗重度脱垂型腰椎间盘突出症[J]. 中国矫形外科杂志, 2022, 30(3): 273-276.

[35] Cao C , Chen S L , Gao Y Z , et al. Unilateral biportal endoscopy for far—migrated lumbar intervertebral disc herniation[J]. Orthop J China, 2022, 30(3): 273-276.

[36] 赵予辉, 薛滨勇, 周立勇, 等 . 单侧双通道内镜和经皮椎间孔镜技术治疗腰椎间盘突出症的对比分析[J]. 局解手术学杂志, 2024, 33(7): 614-618.

[37] Zhao Y H , Xue B Y , Zhou L Y , et al. Comparative analysis of unilateral biportal endoscopy and percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation[J]. J Reg Anat Oper Surg, 2024, 33(7): 614-618.

基金资助

^*江苏省科学技术厅自然科学基金面上项目(BK20211083)