| BackgroundWith the faster and faster pace of society,people’s poor work and rest habits lead to the increase of spinal diseases,especially lumbar disc herniation（LDH）,which shows a younger and younger trend.At the same time,with the enrichment of material life,people have higher and higher requirements for the treatment of lumbar disc herniation.From the previous simple relief of low back and leg pain to the present,we should not only solve the problem of low back and leg pain,but also meet the requirements of ensuring safety,less trauma,short hospital stay and little impact on the whole body.Although traditional surgery has mature technology,fixed surgical process and accurate curative effect,it is accompanied by adverse factors such as large incision trauma,more bleeding,postoperative lumbar and dorsal muscle atrophy,poor recovery of lumbar function and so on.Therefore,doctors and scholars at home and abroad continue to explore safe and effective treatment schemes that have less impact on the whole human body and are more conducive to rapid postoperative recovery by constantly updating surgical instruments and treatment concepts.For patients with lumbar disc herniation,which seriously affects their daily life,surgery is undoubtedly a reliable means.At present,with the increasing updating of technology,there are many surgical methods that can treat lumbar disc herniation,and minimally invasive surgery is gradually integrated into the mainstream,and has become the first choice for the treatment of this disease.Among them,Transforaminal Endoscopic Lumbar Discectomy（TELD）and Unilateral Biportal Endoscopy（UBE）are the hot technologies recently.In the field of traditional surgery,Fenestration Discectomy（FD）is also a less invasive surgical method,and its efficacy and safety have been verified for many years.At present,the level of spinal minimally invasive technology in domestic hospitals is uneven,and there are few studies on the simultaneous comparison of the above three surgical methods at home and abroad.Our hospital can carry out the above three surgical procedures at the same time,so as to enable the majority of patients to obtain a more optimized treatment plan,so this study is carried out.The purpose of this study is to observe the therapeutic effects of three surgical methods: UBE,TELD and FD on single segment simple lumbar disc herniation.By comparing and analyzing the clinical data,it provides a scientific basis for patients to choose a personalized treatment plan in the future.ObjectiveTo clarify the clinical efficacy and safety of UBE,TELD and FD in patients with single segment simple lumbar disc herniation,and show the advantages and disadvantages of the three methods,so as to find a method for patients that can effectively improve the clinical symptoms and signs,improve the clinical efficacy,relieve pain,shorten the length of hospital stay,accelerate the postoperative recovery and improve the satisfaction of patients.MethodsUsing a retrospective study,the data were selected from 90 patients with lumbar disc herniation treated in our hospital（the 83 rd Army Hospital Affiliated to Xinxiang Medical University）from June 2019 to June 2021.Their follow-up data were complete.All of them were single segment simple lumbar disc herniation（L4 / 5 or L5 / S1 segment）.They all underwent conservative treatment for about 3 months and were ineffective.According to the different surgical methods they received,30 patients treated with UBE were selected as group A,30 patients treated with TELD as group B and 30 patients treated with FD as group C.The operation duration,incision size,blood loss,time out of bed after operation and length of hospital stay of the three groups were counted.Three months after operation,we will evaluate the excellent and good rate of the three groups.The pain score（VAS）,lumbar function（JOA）and Oswestry disability index（ODI）of the three groups were evaluated before operation,1 month,2 months and 3 months after operation.The complications（infection,dural sac tear,nerve injury,instrument fracture,protrusion residue,etc.）of the three groups were counted.Evaluate the muscle strength of the lumbodorsal and abdominal muscles of the three groups before and 3 months after operation,evaluate the erythrocyte sedimentation rate and C-reactive protein（CRP）of the three groups before and 1 day and 1 week after operation,and compare the fluoroscopy times of the three groups of operation methods,so as to indirectly evaluate the radiation injury of patients and operators.Based on the above information,compare the advantages and disadvantages of the three operation methods.ResultsThe operation time in group A was less than that in group B and C（P < 0.05）,the incision size in group A was less than that in group C but greater than that in group B（P <0.05）,the blood loss,postoperative out of bed time and hospitalization time in group A and group B were less than those in group C（P < 0.05）,and there was no significant difference between group UBE and group TELD（P > 0.05）.The excellent and good rate among the three groups was not statistically significant（P > 0.05）.The VAS scores of the three groups before operation were not significant（P > 0.05）,but the VAS scores of group A and group B at 1 month,2 months and 3 months after operation were lower than those of group C（P< 0.05）.There was no significant difference between group UBE and group TELD（P >0.05）.The JOA scores of the three groups before operation were not significant（P > 0.05）,but the JOA scores of group A and group B at 1 month,2 months and 3 months after operation were higher than those of group C（P < 0.05）.There was no significant difference between group UBE and group TELD（P > 0.05）.The ODI scores of the three groups before operation were not significant（P > 0.05）,but the ODI scores of group A and group B at 1 month,2 months and 3 months after operation were lower than those of group C（P< 0.05）.There was no significant difference between group UBE and group TELD（P >0.05）.The incidence of complications in group A was 3.33%,which was lower than10.00% and 16.67% in group B and C,but there was no significant difference（P > 0.05）.Before operation,there was no difference in the muscle strength of lumbodorsal and abdominal muscles among the three groups（P > 0.05）.After operation,the muscle strength of lumbodorsal and abdominal muscles in group A and group B was higher than that in group C（P < 0.05）.There was no significant difference between group UBE and group TELD（P > 0.05）.There was no difference in inflammatory factors among the three groups before operation（P > 0.05）.One day after operation and one week after operation,ESR and CRP in group A and group B were lower than those in group C（P < 0.05）.There was no significant difference between group UBE and group TELD（P > 0.05）.The number of fluoroscopy in group B was greater than that in group A and group C（P < 0.05）,and there was no difference between group A and group C（P > 0.05）.Conclusions1.In dealing with the problem of single segment simple lumbar disc herniation,compared with FD,the comprehensive effect of UBE and TELD is more significant.2.Compared with TELD,the trauma of UBE is slightly larger than that of TELD,but the short-term and long-term effect are not inferior to TELD.Moreover,Ube can effectively control radiation injury,has a wider range of indications,shorter learning curve,more efficient in dealing with problems such as spinal canal stenosis and intervertebral disc herniation,and is easier to promote. |
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