| Objective:To explore the surgical tolerance,symptom improvement,imaging changes,and subsequent complications of patients with L5/S1single-level lumbar disc herniation after treatment with UBE(Unilateral biportal endoscopy)and PELD(Percutaneous Endoscopic Lumbar Discectomy),so as to compare and analyze the advantages and disadvantages of the two surgical techniques,so as to better select the appropriate surgical methods for patients.Methods:In this retrospective study,a total of 60 patients with L5/S1single-level lumbar disc herniation were collected at the Orthopaedic Medicine Center,the Second Hospital of Jilin University from December2020 to December 2021.30 patients accepted UBE treatment and 30patients accepted PELD treatment.Follow-up data were complete,which met the inclusion and exclusion criteria.The patients were divided into UBE group and PELD group according to different surgical methods.Symptom improvement was assessed by Visual Analog Scale(VAS)and Oswestry Disability Index(ODI)before the surgery and at 1 week,3months,1 year after surgery.Preoperative tolerance was evaluated by operative time,number of incisions,length of incisions,and length of hospital stay.MRI was used 12 months after surgery to compare the recovery of vertebral canal volume and evaluate the effect of surgical decompression.The segmental degeneration was evaluated by MRI 12months after surgery using pffirrmann grading.The changes of intervertebral height were compared by X-ray 12 months after operation.Based on the above information,the advantages and disadvantages of the two surgical techniques were analyzed.Results:A total of 60 patients who met the inclusion criteria received UBE and PELD between December 2020 and December 2021.A total of 16male patients and 14 female patients in the UBE group were followed up by telephone,Wechat or outpatient service,with an average age of(45.67±7.51)years.In the PELD group,there were 18 males and 12females,with an average age of(44.84±8.03)years,and there were no statistical differences in age and gender between the two groups(P>0.05).The average operation time of the UBE group was(60.35±10.38)min,and that of the PELD group was(73.77±11.36)min.The average operation time of the UBE group was shorter,and the difference was statistically significant.(P<0.05),two incisions were required in the UBE group,while only one incision was required in the PELD group,and the incision length of the UBE group was longer than that in the PELD group,with statistical difference(P>0.05).The average length of stay was(5.33±2.22)days in the UBE group and(4.97±1.73)days in the PELD group,and there was no significant difference between the two groups(P>0.05).In the UBE group,there was 1 case of transient numbness,1 case of dural tear,and 0 cases of surgical segment reprotrusion.In the PELD group,there were 0 cases of dural tear,2 cases of transient lower limb numbness,and 1 case of surgical segment reemergence.There was no statistical difference in the incidence of postoperative complications between the two groups(P>0.05).Preoperative VAS score was 6.75±1.33 in the UBE group and 7.04±0.87in the PELD group,and there was no significant difference between the two groups(P>0.05).The VAS score of the UBE group decreased to(1.46±0.58)one week after surgery,(1.29±0.43)at the three-month follow-up and(1.07±0.52)at the one-year follow-up.The VAS score of the PELD group decreased to(1.39±0.54)one week after surgery,(1.36±0.47)at three-month follow-up,and(1.11±0.65)at one-year follow-up.VAS scores in the UBE group and PELD group were significantly lower than those before surgery,with statistical difference(P<0.05).There was no significant difference in VAS scores between the UBE group and the PELD group at each time point during follow-up(P>0.05).The preoperative ODI score was(60.53±4.73)in the UBE group and(59.63±4.98)in the PELD group,with no statistical difference between the two groups(P>0.05).The ODI score of the UBE group decreased to(11.93±2.68)one week after surgery,and was(8.50±1.80)at the three-month follow-up and(8.47±1.66)at the one-year follow-up.The ODI score of the PELD group decreased to(12.13±3.07)one week after the surgery,and was(8.87±1.74)at the three-month follow-up and(8.40±1.81)at the one-year follow-up.The ODI scores of UBE group and PELD group were significantly decreased compared with those before surgery,with statistical difference(P<0.05).There was no significant difference in ODI scores between the UBE group and the PELD group at each time point during follow-up(P>0.05).Postoperative 3D-CT showed that the lamina area removed was(135.88±52.38)mm~2 in the UBE group,(100.92±66.73)mm~2 in the PELD group,and the area removed was more in the UBE group,with statistical difference(P<0.05).The average dural sac area increased from(85.78±27.46)mm~2 to(158.92±23.24)mm~2 in the UBE group and from(92.29±25.63)mm~2 to(142.36±26.78)mm~2 in the single channel group.The average dural sac area after surgery was significantly increased in both groups compared with that before surgery(P<0.05).In addition,postoperative dural sac dilatation in the UBE group was significantly better than that in the PELD group,and the difference between the two groups was statistically significant(P<0.05).At the follow-up 12 months after surgery,a total of2 patients in the UBE group and 1 patient in the PELD group showed further surgical level degeneration,with no statistical significance(P>0.05).The L5/S1 intervertebral space height before surgery was(8.24±2.17)mm in the UBE group and(7.83±3.04)mm in the PELD group,with no statistical significance(P>0.05).The L5/S1 intervertebral space height was(7.94±3.22)mm in the UBE group and(7.69±3.43)mm in the PELD group,and there was no statistical significance between the two groups or compared with the preoperative level(P>0.05).Conclusion:In this study,by comparing the effects of UBE and posterior transforaminal endoscopy in the treatment of L5/S1 single-segment lumbar disc herniation,the following conclusions were drawn:Both UBE technique and intervertebral PELD can well solve the problem of L5/S1single-segment lumbar disc herniation.The corresponding symptoms of lumbar disc herniation,and the prognosis is good,and the technique of annulus fibrosus suture can avoid re-herniation to a certain extent.There are fewer incisions,less soft tissue and bone destruction,and less trauma to the patient with PELD.PELD and UBE had no significant effect on the functional recovery of lumbodorsal muscle and spinal stability..The UBE technique has a better effect on restoring the volume of the spinal canal,and is more suitable for partial-central herniated intervertebral discs.With the support of dual channels,UBE technology has a clearer field of vision and a wider operating space,and uses traditional arthroscopy and spinal surgery instruments,so it has higher surgical efficiency and shorter learning curve,so it has more great promotional value. |
PDF Full Text Request