单侧双通道内镜微创髓核摘除手术治疗腰椎间盘突出的效果及其对JOA评分影响

  目的  探究并分析单侧双通道内镜技术（UBE）在腰椎间盘突出（LDH）患者的治疗效果及其对日本骨科学会（JOA）评分的影响。  方法  选取2020年10月~2021年12月收治的69例LDH患者，按照随机数字表法将其分为观察组（n=34）和对照组（n=35）。对照组采用后路切开髓核摘除椎弓根内固定椎间融合治疗治疗，观察组采用UBE进行治疗。观察两组患者一般资料（年龄、性别、病变区域、手术的时间、病程、出血量等）、手术前后评分即视觉模拟评分（VAS）、JOA评分、腰痛Oswestry功能障碍指数（ODI）评分。  结果  两组患者术前VAS评分差异无统计学意义（P>0.05），术后VAS评分均较术前下降（P<0.05），观察组患者术后1、24、72 h的VAS评分较对照组下降（P<0.05）；两组患者术前JOA评分差异无统计学意义（9.34±0.33 vs 9.23±0.43，P>0.05），术后JOA评分均较术前升高（P<0.05），术后6月观察组患者的JOA评分高于对照组（15.54±0.52 vs 14.23±0.43，P<0.05）；两组患者术前ODI评分差异无统计学意义（15.43±3.54 vs 15.74±3.34，P>0.05），术后1月、6月两组ODI评分较术前升高（P<0.05），术后6月观察组患者ODI评分高于对照组（51.43±3.73 vs 48.75±3.64, P<0.05）。两组患者术前血清HMGB1、IL-6水平差异无统计学意义（4.43±0.54 vs 4.41±0.65、44.74±4.25 vs 45.54±4.54，P>0.05），术后1月、6月两组患者较术前均有升高（P<0.05），且观察组患者术后6月均较对照组降低（5.4±0.54 vs 6.54±0.32、46.85±4.45 vs 52.63±4.41，P<0.05）。  结论  UBE手术较后路切开髓核摘除椎弓根内固定椎间融合术更能有效降低LDH患者的疼痛程度，改善患者腰椎稳定性，值得临床推广。 

Effect of unilateral biportal endoscopic minimally invasive nucleus pulposus enucleation on lumbar disc herniation and effect on JOA score

  Objective  To explore and analyze the effete of unilateral biportal endoscopic (UBE) surgery in lumbar disc herniation (LDH) and its effect on JOA score.  Methods  A total of 69 patients with lumbar disc herniation admitted from October 2020 to December 2021 were randomly divided into observation group (n=34) and control group (n=35) according to random number table method. The patients in the control group were treated with Posterior incision of nucleus pulposus, removal of pedicle, internal fixation and interbody fusion, and the patients in the observation group were treated with UBE. The general data of the two groups (gender, age, lesion location, course of disease, operation time, blood loss, etc. were observed, and the visual analog scale (VAS) score, JOA score and Oswestry disability index (ODI) score before and after operation were evaluated.  Results  There was no significant difference in VAS score between two groups before operation (P> 0.05), but the VAS score of the two groups after operation was significantly lower than that before operation (P<0.05), and the VAS score of the observation group was significantly lower than that of control group at 1, 24, 72 h after operation (P<0.05); There was no significant difference between the two groups before operation (9.34±0.33 vs 9.23±0.43, P>0.05), and the JOA score of the two groups after operation was significantly higher than that before operation (P<0.05), which in the observation group was significantly higher than that in control group 6 months after operation (15.54±0.52 vs 14.23±0.43, P<0.05); There was no significant difference of ODI score between the two groups before operation (15.43±3.54 vs 15.74±3.34, P>0.05), but the ODI score of the two groups 1 month and 6 months after operation was significantly higher than that before operation (P<0.05), and the ODI score of the observation group 6 months after operation was significantly higher than that of control group (51.43±3.73 vs 48.75±3.64, P<0.05); There was no significant difference in the levels of serum HMGB1 and IL-6 between the two groups before operation (4.43±0.54 vs 4.41±0.65, 44.74±4.25 vs 45.54±4.54, P>0.05), but the levels of serum HMGB1 and IL-6 in the two groups 1 month and 6 months after operation were significantly higher than those before operation (P<0.05), and the levels of patients in the observation group were significantly lower than those in control group 6 months after operation (5.4±0.54 vs 6.54±0.32, 46.85±4.45 vs 52.63±4.41, P<0.05).  Conclusion  Compared with traditional disc arthroscopy, UBE surgery can effectively reduce the degree of pain and improve lumbar stability in patients with Posterior incision of nucleus pulposus, removal of pedicle, internal fixation and interbody fusion, which is worthy of clinical promotion.