【摘要】 目的:比较经皮单通道与经皮单侧双通道脊柱内镜下髓核摘除术治疗腰椎间盘突出症的临床疗效。方法:选取2018年6月至2020年4月在周口市中心医院住院治疗的腰椎间盘突出症患者为研究对象。采用随机数字表将符合要求的患者随机分为单通道组和单侧双通道组。2组均采用经皮脊柱内镜下髓核摘除术治疗，其中单通道组采用经皮单通道技术、单侧双通道组采用经皮单侧双通道技术。观察记录患者的切口长度、手术时间。采用疼痛视觉模拟量表(visual analogue scale, VAS)评分评价腰部疼痛情况，采用Oswestry功能障碍指数(Oswestry disability index, ODI)评价腰椎功能。术后6个月，采用日本骨科协会(Japanese Orthopaedic Association, JOA)腰痛疾患疗效评分标准评价综合疗效。结果:共纳入60例患者，单通道组和单侧双通道组各30例。(1)一般指标。单通道组的切口长度和手术时间均短于单侧双通道组[(0.77±0.18)cm,(1.52±0.59)cm,t=2.583,P=0.012;(43.57±9.42)min,(50.64±10.66)min,t=2.156,P=0.035]。(2)腰部疼痛VAS评分。时间因素与分组因素不存在交互效应(F=2.380,P=0.119)。2组患者腰部疼痛VAS评分总体比较，组间差异有统计学意义，即存在分组效应(F=17.195,P=0.000)。手术前后不同时间点腰部疼痛VAS评分的差异有统计学意义，即存在时间效应(F=1 352.911,P=0.000)。2组患者的腰部疼痛VAS评分随时间变化均呈下降趋势，但2组的下降趋势不完全一致(F=1 058.132,P=0.000;F=447.262,P=0.000)。术前、术后6个月，2组患者腰部疼痛VAS评分的组间差异均无统计学意义[(8.19±1.07)分，(8.45±1.59)分，t=0.647,P=0.428;(0.59±0.10)分，(0.61±0.18)分，t=0.289,P=0.595]。术后1 d、3个月，单通道组腰部疼痛VAS评分均低于单侧双通道组[(3.24±0.27)分，(4.03±0.56)分，t=62.087,P=0.000;(1.04±0.32)分，(1.43±0.76)分，t=6.174,P=0.019]。(3)ODI。术前、术后6个月，2组患者ODI比较，组间差异均无统计学意义[(45.32±11.67)%,(44.67±10.59)%,t=0.589,P=0.558;(2.81±0.87)%,(3.05±1.03)%,t=1.256,P=0.214]。术后6个月，2组患者ODI均较术前降低(t=22.561,P=0.000;t=23.478,P=0.000)。(4)JOA评分。术前、术后6个月，2组患者JOA评分比较，组间差异均无统计学意义[(8.69±2.53)分，(9.07±1.97)分，t=0.789,P=0.433;(27.98±3.21)分，(28.14±4.05)分，t=1.274,P=0.208]。术后6个月，2组患者JOA评分均较术前增高(t=25.698,P=0.000;t=25.017,P=0.000)。(5)综合疗效。术后6个月，单通道组优16例、良11例、可3例，单侧双通道组优15例、良10例、可5例。2组患者的综合疗效比较，差异无统计学意义(Z=-0.450,P=0.653)。结论:经皮单通道与经皮单侧双通道脊柱内镜下髓核摘除术治疗腰椎间盘突出症，二者的疗效相当，但后者的切口和手术时间相对较长。更多还原

【Abstract】 Objective:To compare the clinical outcomes of percutaneous endoscopic spinal discectomy through uniportal versus unilateral biportal for treatment of lumbar disc herniation(LDH).Methods:The LDH patients who were treated in Zhoukou Central Hospital from June 2018 to April 2020 were selected as the subjects.Sixty patients were enrolled in the study, and were randomly divided into uniportal group and unilateral biportal group by using random digits table, 30 cases in each group.All patients in the 2 groups were treated with percutaneous endoscopic spinal discectomy.The patients in uniportal group were treated through uniportal, and the ones in unilateral biportal group through unilateral biportal.The incision length and operative time were observed and recorded.The low back pain and lumbar function were evaluated by using pain visual analogue scale(VAS)score and Oswestry disability index(ODI)respectively, and the total clinical outcomes were evaluated by using Japanese Orthopaedic Association(JOA)therapeutic effect rating standards for low back pain on month 6 after the surgery. Results:(1)The incision length and operative time were shorter in uniportal group compared to unilateral biportal group( 0. 77 ± 0. 18 vs 1. 52 ± 0. 59 cm,t = 2. 583,P = 0. 012; 43. 57 ± 9. 42 vs 50. 64 ± 10. 66 minutes,t = 2. 156,P = 0. 035).(2)There was no interaction between time factor and group factor in low back pain VAS score( F = 2. 380,P = 0. 119). There was statistical difference in the low back pain VAS scores between the 2 groups in general,in other words,there was group effect( F = 17. 195,P = 0. 000). There was statistical difference in low back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect( F = 1 352. 911,P = 0. 000). The low back pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2groups were inconsistent with each other in the variation tendency( F = 1 058. 132,P = 0. 000; F = 447. 262,P = 0. 000). There was no statistical difference in low back pain VAS scores between the 2 groups before the surgery and on month 6 after the surgery( 8. 19 ± 1. 07 vs8. 45 ± 1. 59 points,t = 0. 647,P = 0. 428; 0. 59 ± 0. 10 vs 0. 61 ± 0. 18 points,t = 0. 289,P = 0. 595). The low back pain VAS scores were lower in uniportal group compared to unilateral biportal group on day 1 and month 3 after the surgery( 3. 24 ± 0. 27 vs 4. 03 ± 0. 56 points,t = 62. 087,P = 0. 000; 1. 04 ± 0. 32 vs 1. 43 ± 0. 76 points,t = 6. 174,P = 0. 019).(3)There was no statistical difference in ODI between the2 groups before the surgery and on month 6 after the surgery( 45. 32 ± 11. 67 vs 44. 67 ± 10. 59%,t = 0. 589,P = 0. 558; 2. 81 ± 0. 87 vs3. 05 ± 1. 03%,t = 1. 256,P = 0. 214). The ODI decreased in the 2 groups on month 6 after the surgery compared to pre-surgery( t =22. 561,P = 0. 000; t = 23. 478,P = 0. 000).(4)There was no statistical difference in JOA scores between the 2 groups before the surgery and on month 6 after the surgery( 8. 69 ± 2. 53 vs 9. 07 ± 1. 97 points,t = 0. 789,P = 0. 433; 27. 98 ± 3. 21 vs 28. 14 ± 4. 05 points,t =1. 274,P = 0. 208). The JOA score increased in the 2 groups on month 6 after the surgery compared to pre-surgery( t = 25. 698,P =0. 000; t = 25. 017,P = 0. 000).(5)The total clinical outcomes were evaluated on month 6 after the surgery. Sixteen patients obtained an excellent result,11 good and 3 fair in uniportal group; while 15 ones obtained an excellent result,10 good and 5 fair in unilateral biportal group. There was no statistical differences in the total clinical outcomes between the 2 groups( Z =-0. 450,P = 0. 653). Conclusion: Percutaneous endoscopic spinal discectomy through uniportal is similar to percutaneous endoscopic spinal discectomy through unilateral biportal in the clinical outcomes in treatment of LDH,while the former displays the advantages of shorter incision length and operative time compared to the latter.更多还原