[1]徐泽华 熊敏** 张轩 韩珩 唐冰 何涛.单边双通道内镜与单通道Delta内镜腰椎融合术治疗腰椎退行性疾病的对比[J].中国微创外科杂志,2023,01(5):347-353.
　Xu Zehua,Xiong Min,Zhang Xuan,et al.Comparison of Efficacy of Unilateral Biportal Endoscopic and Uniportal Delta Endoscopic Lumbar Interbody Fusion for Lumbar Degenerative Diseases[J].Chinese Journal of Minimally Invasive Surgery,2023,01(5):347-353.
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单边双通道内镜与单通道Delta内镜腰椎融合术治疗腰椎退行性疾病的对比()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年5期
页码:
347-353
栏目:
临床研究
出版日期:
2023-05-25

文章信息/Info

Title:
Comparison of Efficacy of Unilateral Biportal Endoscopic and Uniportal Delta Endoscopic Lumbar Interbody Fusion for Lumbar Degenerative Diseases
作者:
徐泽华 熊敏** 张轩 韩珩 唐冰 何涛
(湖北医药学院附属国药东风总医院脊柱外科，十堰442008)
Author(s):
Xu Zehua;  Xiong Min;  Zhang Xuan;  et al.
Department of Spine Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan 442008, China
关键词:
单边双通道内镜; 单通道Delta内镜; 腰椎融合术; 腰椎退行性疾病
Keywords:
Unilateral biportal endoscopy; Uniportal Delta endoscopy; Lumbar spinal fusion; Lumbar degenerative disease
文献标志码:
A
摘要:
目的比较单边双通道内镜(unilateral biportal endoscopy，UBE)与单通道Delta内镜腰椎融合术治疗腰椎退行性疾病的早期疗效及安全性。方法回顾性分析我院2020年10月~2021年10月46例内镜下腰椎椎间融合术治疗单节段腰椎退行性疾病的资料，其中19例采用UBE，27例采用Delta内镜。比较2组手术时间、术中出血量、术中透视次数、术后住院时间及术后并发症，以及术前和术后1个月、3个月、末次随访时疼痛视觉模拟评分(Visual Analogue Scale，VAS)、Oswestry功能障碍指数(Oswestry Disability Index，ODI)、日本骨科协会(Japanese Orthopedic Association，JOA)评分，末次随访采用改良MacNab标准评估疗效。结果2组手术顺利完成，未出现严重并发症。UBE组手术时间短［(158.4±13.6)min vs. (196.6±17.3)min，t=-7.996，P=0.000］，2组术中出血量、透视次数、术后住院时间、术后并发症等差异无统计学意义(P>0.05)。2组术后随访9~16个月，(12.2±1.6)月。术后2组疼痛VAS评分及ODI均显著降低(P<0.05)，JOA评分显著增加(P<005)，2组间差异均无统计学意义(P>0.05)。末次随访2组改良MacNab标准优良率差异无统计学意义［89.5%(17/19) vs. 88.9%(24/27)， χ2=0.000，P=1.000］。结论UBE与单通道Delta内镜腰椎融合术治疗腰椎退行性疾病均能够达到良好的临床效果。UBE操作空间更灵活，可使用常规手术器械，更具推广潜力。
Abstract:
ObjectiveTo compare the early treatment outcomes and safety of unilateral biportal endoscopic (UBE) and uniportal Delta endoscopic lumbar fusion for lumbar degenerative diseases. Methods A retrospective analysis was performed on 46 patients with unisegment lumbar degenerative diseases who underwent endoscopic lumbar interbody fusion in our hospital from October 2020 to October 2021, among which 19 patients received UBE and 27 patients received Delta endoscopy. The operative time, intraoperative bleeding, number of intraoperative fluoroscopies, postoperative hospital stay and postoperative complications as well as the preoperative and postoperative Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores at 1 month, 3 months, and final followup were compared between the two groups. The modified MacNab criteria was used for assessment of surgical efficacy at final followup.ResultsThe operations of the two groups were successfully completed without serious complications. The operative time in the UBE group was less than the Delta endoscopy group ［(158.4±136) min vs. (196.6±17.3) min, t=-7.996, P=0.000］. The differences in intraoperative bleeding, number of fluoroscopy, postoperative hospital stay, and postoperative complications between the two groups were not statistically significant (P>0.05). Both groups were followed up for 9-16 months after surgery, with a mean of (12.2±1.6) months. The pain VAS score and ODI decreased significantly in both groups (P<0.05), while the JOA score increased significantly (P<0.05). The differences were not statistically significant between the two groups (P>0.05). There was no statistically significant difference in the excellent and good rate of modified MacNab criteria between the two groups at the final followup ［89.5% (17/19) vs. 88.9% (24/27), χ2=0.000, P=1000］.ConclusionBoth unilateral biportal endoscopic and uniportal Delta endoscopic lumbar fusion can achieve good clinical results in the treatment of lumbar degenerative diseases, but unilateral biportal endoscopy has more flexible operating space and can use conventional surgical instruments, which has more potential to be popularized.

参考文献/References:

[1]Song Q,Zhu B,Zhao W,et al.Fullendoscopic lumbar decompression versus open decompression and fusion surgery for the lumbar spinal stenosis:a 3year followup study.J Pain Res,2021,14:1331-1338.
[2]Cho JH,Lee JH,Song KS,et al.Treatment outcomes for patients with failed back surgery.Pain Physician,2017,20(1):E29-E43.
[3]Ahn Y,Youn MS,Heo DH.Endoscopic transforaminal lumbar interbody fusion:a comprehensive review.Expert Rev Med Devices,2019,16(5):373-380.
[4]Xie P,Feng F,Chen Z,et al.Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis.BMC Musculoskelet Disord,2020,21(1):546.
[5]薛文,王栋,管晓鹂,等.脊柱内镜辅助套管内微创经椎间孔椎体间融合术的初步应用.中国微创外科杂志,2019,19(8):756-759.
[6]常献,李长青.经皮内镜辅助腰椎椎间融合术现状与思考.中国修复重建外科杂志,2022,36(6):660-664.
[7]Heo DH,Son SK,Eum JH,et al.Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results.Neurosurg Focus,2017,43(2):E8.
[8]Li Y,Dai Y,Wang B,et al.Fullendoscopic posterior lumbar interbody fusion via an interlaminar approach versus minimally invasive transforaminal lumbar interbody fusion:a preliminary retrospective study.World Neurosurg,2020,144:e475-e482.
[9]Heo DH,Eum JH,Jo JY,et al.Modified far lateral endoscopic transforaminal lumbar interbody fusion using a biportal endoscopic approach:technical report and preliminary results.Acta Neurochir (Wien),2021,163(4):1205-1209.
[10]Turner NM,van de Leemput AJ,Draaisma JM,et al.Validity of the visual analogue scale as an instrument to measure selfefficacy in resuscitation skills.Med Educ,2008,42(5):503-511.
[11]阿海,关炳瑜,王晓锋,等.椎间孔镜髓核摘除术治疗老年单节段腰椎间盘突出症临床疗效分析.中国医学前沿杂志(电子版),2018,10(5):69-73.
[12]Fujimori T,Okuda S,Iwasaki M,et al.Validity of the Japanese Orthopaedic Association scoring system based on patientreported improvement after posterior lumbar interbody fusion.Spine J,2016,16(6):728-736.
[13]Choi G,Lee SH,Lokhande P,et al.Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope.Spine (Phila Pa 1976),2008,33(15):E508-E515.
[14]Said E,AbdelWanis ME,Ameen M,et al.Posterolateral fusion versus posterior lumbar interbody fusion: a systematic review and metaanalysis of randomized controlled trials.Global Spine J,2022,12(5):990-1002.
[15]林光勋,陈建民.脊椎内镜手术的发展现况及未来展望.西安交通大学学报(医学版),2022,43(1):30-36.
[16]Kim JE,Yoo HS,Choi DJ,et al.Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for singlelevel lumbar disease.Clin Spine Surg,2021,34(2):E64-E71.
[17]张斌,孔清泉,戎利民.经皮内镜辅助腰椎椎间融合术的技术利弊分析及趋势展望.中国修复重建外科杂志,2022,36(6):653-659.
[18]Shen J.Fully endoscopic lumbar laminectomy and transforaminal lumbar interbody fusion under local anesthesia with conscious sedation: a case series.World Neurosurg,2019,127:e745-e750.
[19]刘鏐,谷艳超,李莹.Delta椎板间内镜技术与开放经椎间孔入路椎间融合术治疗单节段腰椎失稳的对比研究.骨科,2022,13(2):110-114.
[20]Eum JH,Heo DH,Son SK,et al.Percutaneous biportal endoscopic decompression for lumbar spinal stenosis:a technical note and preliminary clinical results.J Neurosurg Spine,2016,24(4):602-607.

备注/Memo

备注/Memo:
基金项目：国药东风总医院2021年度卓越计划硕导项目(2021S12)；国药东风总医院2022年度卓越计划青年人才项目(2022Q08，2022Q09)**通讯作者，Email：xiongmin1964@163.com
更新日期/Last Update: 2023-08-10