单侧双侧内窥镜椎间盘切除术与层间显微椎间盘切除术在治疗腰椎间盘突出症中的有效性比较评估

Volodymyr S. Balan, I. Fishchenko, Lyudmila D. Kravchuk, Yevhenii E. Shcheholkov
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引用次数: 0

摘要

本研究旨在对腰椎间盘突出症患者接受单侧双侧内窥镜椎间盘切除术和椎板间显微椎间盘切除术的效果进行比较分析。材料和方法。研究于 2021 年 5 月至 2022 年 8 月在伊万诺-弗兰科夫斯克地区临床医院脊柱和脊髓神经外科进行。样本包括 99 名椎间盘突出症患者(L2-L3、L3-L4、L4-L5、L5-S1 水平),其中男性 44 名,女性 57 名。组间分布标准:第1组(n = 43)--采用单侧双侧内窥镜椎间盘切除术切除椎间盘突出;第2组(n = 56)--采用层间显微椎间盘切除术。检查方法分别为 1 个月、6 个月和 12 个月后的 VAS(厘米)和 Oswestry 问卷调查。使用 Microsoft Excel 和 Statistica 8.0 (StatSoft Inc.) 对结果进行统计处理。结果术前,第一组和第二组的背痛指数分别为 6,9±1,1 和 6,7±1,4。术后,第 1 组的 VAS 背痛指数从 6.9±1.1 厘米降至次日的 1.9±0.5 厘米,在观察的一年中分别保持了 0.2±0.2 厘米的正动态变化。第 2 组患者出院时的疼痛指数为 3.5±0.9 厘米,随后逐渐改善为 0.7±0.5 厘米。术后 1 个月对腿部根性疼痛严重程度的评估显示,两组患者的疼痛程度均有明显改善:第 1 组从 7.2±0.6 厘米降至 0.5±0.5 厘米,第 2 组从 7.8±0.5 厘米降至 0.5±0.3 厘米。在最后一次调查中,各观察组之间未发现明显差异。使用内窥镜入路时的手术时间分别为(35,7±15,2 min (M±SD))和(45,8±13,7 min (M±SD))(р≤0, 05),低于显微椎间盘切除术。内镜入路时的失血量分别为(35,4±18,9 ml (M±SD))和(122,2±90,9 ml (M±SD))(р≤0,05)的3.8倍。内窥镜椎间盘切除术组的住院时间更短。结论与开放式显微椎间盘切除术相比,单侧双侧内窥镜显微椎间盘切除术创伤小,能让患者更快地恢复积极的生活方式。在远期观察阶段,VAS和Oswestry指标未发现明显差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
EVALUATION OF THE EFFECTIVENESS OF UNILATERAL BIPORTAL ENDOSCOPIC DISCECTOMY IN COMPARISON WITH INTERLAMINAR MICRODISCECTOMY IN THE TREATMENT OF HERNIATED INTERVERTEBRAL DISCS OF THE LUMBAR SPINE
The aim of the study is to conduct a comparative analysis of the effectiveness of the methods of unilateral biportal endoscopic discectomy and interlaminar microdiscectomy among patients operated on for herniated intervertebral discs of the lumbar spine. Materials and methods. The study was conducted at the Department of spine and spinal cord neurosurgery of the Regional Clinical Hospital of the Ivano-Frankivsk from May 2021 to August 2022. The sample consisted of 99 patients with intervertebral disc herniation (at the level of L2-L3, L3-L4, L4-L5, L5-S1), including 44 men and 57 women. Criteria for intergroup distribution: group 1 (n = 43) – removal of the intervertebral disc herniation was performed by the method of unilateral biportal endoscopic discectomy; group 2 (n = 56) – interlaminar microdiscectomy was performed. Examination methods - VAS (cm), Oswestry questionnaire after 1 month, 6 and 12 months, respectively. Statistical processing of the results was carried out using Microsoft Excel and Statistica 8.0 (StatSoft Inc.). Results. In the preoperative period, the back pain index was 6,9±1,1 and 6,7±1,4 in groups 1 and 2, respectively. In the postoperative period in group 1, the back pain index according to VAS decreased from 6,9±1,1 cm to 1,9±0,5 cm the next day, with positive dynamics remaining during the year of observation of 0,2±0,2 cm, respectively. In group 2, at the time of discharge, the pain index was noted at the level of 3,5 ± 0,9 cm with a gradual improvement to 0,7 ± 0,5 cm. Assessment of the severity of radicular pain in the leg in the postoperative period after 1 month showed a significant improvement in both groups: in group 1 from 7,2±0,6 cm to 0,5±0,5 and in group 2 from 7,8±0,5 cm to 0,5±0,3 cm. Significant differences between observation groups during the last survey was not detected. The duration of the operation when using endoscopic access was lower than during microdiscectomy (35,7±15,2 min (M±SD)) and (45,8±13,7 min (M±SD)), respectively (р≤0, 05). The amount of blood loss was 3,8 times less determined during endoscopic access ((35,4±18,9 ml (M±SD)) and (122,2±90,9 ml (M±SD)), respectively (р≤0,05). The length of stay in the hospital was shorter in the endoscopic discectomy group. Conclusions. The method of unilateral biportal endoscopic microdiscectomy, due to its low trauma, allows the patient to return to an active lifestyle more quickly compared to open microdiscectomy. No significant differences were found according to VAS and Oswestry indicators at the remote stage of observation.
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