Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China.
Department of Neurology, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China.
J Orthop Surg Res. 2023 Sep 9;18(1):668. doi: 10.1186/s13018-023-04159-9.
Lumbar disk herniation (LDH) is one of the most common diseases of the spine, especially occurring in L4-5 and L5-S1 intervertebral disks, and surgery is a choice when conservative treatment is ineffective. The purpose of this study is to investigate the clinical efficacy and radiologic outcomes of one-hole split endoscopy (OSE) technique versus unilateral biportal endoscopy (UBE) technique in the treatment of L5-S1 lumbar disk herniation (LDH).
A total of 133 patients of a single center surgically treated for L5-S1 LDH between 2019 and 2021 were retrospectively included in this study, of which 70 were treated by UBE technique and the rest were treated by OSE technique. Hospitalization time, operative time, intraoperative blood loss, fluoroscopy times, incision length and related complications were recorded. Bone resection area (BRA), articular process resection rate, range of motion (ROM), sagittal translation (ST), disk height (DH), Visual Analog Score (VAS), Oswestry Disability Index (ODI) and Macnab criteria were used to evaluated the clinical efficacy.
There was no statistically significant difference in hospitalization time or fluoroscopy times between the two groups. The operation time was shorter in the UBE group than that in the OSE group; however, the incision length was longer. Intraoperative blood loss and BRA were larger in the UBE group than in the OSE group. There was no significant difference in ROM, ST, DH, or postoperative facet resection rate between the two groups. There was no significant difference in ROM, ST, or postoperative facet resection rate compared with preoperative indicators in each group, but there was a significant difference in DH among distinct groups. At any time point, the lower back and leg VAS and ODI in each group were significantly improved compared to those before the operation, with no significant difference between the two groups. There was one case of dural tear in the UBE group. One case of transient hypoesthesia occurred in each of the two groups. The excellent-good rates of the UBE group and the OSE group were 88.6% and 90.5%, respectively.
The OSE technique is an effective minimally invasive surgical option as well as the UBE technique in the treatment of L5-S1 LDH.
腰椎间盘突出症（LDH）是脊柱最常见的疾病之一，尤其常见于 L4-5 和 L5-S1 椎间盘，当保守治疗无效时，手术是一种选择。本研究旨在探讨单孔双通道内镜（OSE）技术与单侧双通道内镜（UBE）技术治疗 L5-S1 腰椎间盘突出症（LDH）的临床疗效和影像学结果。
回顾性分析 2019 年至 2021 年期间在单中心接受手术治疗的 133 例 L5-S1LDH 患者，其中 70 例采用 UBE 技术治疗，其余采用 OSE 技术治疗。记录住院时间、手术时间、术中出血量、透视次数、切口长度及相关并发症。采用骨切除面积（BRA）、关节突切除率、活动度（ROM）、矢状位平移（ST）、椎间盘高度（DH）、视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）和 Macnab 标准评估临床疗效。
两组患者住院时间和透视次数无统计学差异。UBE 组手术时间短于 OSE 组，切口长度长于 OSE 组。UBE 组术中出血量和 BRA 大于 OSE 组。两组 ROM、ST、DH 或术后小关节切除率无统计学差异。两组患者术后各指标与术前比较无明显差异，但不同组间 DH 存在明显差异。在任何时间点，两组患者的腰痛和腿痛 VAS 和 ODI 均较术前明显改善，两组间无明显差异。UBE 组发生 1 例硬脊膜撕裂，两组各发生 1 例一过性感觉迟钝。UBE 组和 OSE 组的优良率分别为 88.6%和 90.5%。
OSE 技术与 UBE 技术一样，是治疗 L5-S1LDH 的有效微创治疗选择。
