Clinical Efficacy of V-Shaped Double-channel Spinal Endoscopic Technique （VBE） in Patients with LDH and Lumbar Instability
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摘要:
目的 以常规经椎间孔椎间融合术（TLIF）为对照，分析V形双通道脊柱内镜技术（VBE）治疗腰椎间盘突出症（LDH）伴腰椎不稳的效果。 方法 选取2021年1月至2023年3月昆明市官渡区人民医院和上海市第十人民医院收治的102例LDH伴腰椎不稳患者，以随机分组软件分为TLIF组（予以TLIF术，n = 51）、VBE组（予以VBE手术，n = 51）。比较2组手术一般情况、围手术期疼痛程度（VAS评分）、手术前后腰痛与下肢痛程度（VAS评分）、腰椎稳定性（椎间隙高度、腰椎前凸角）、减压效果（硬膜囊横断面积、椎间孔面积）、功能预后及并发症情况。 结果 VBE组术中出血量少于TLIF组，切口长度、卧床时间、住院时间短于TLIF组（P < 0.05）；VBE组术后6 h、术后12 h、术后24 h、术后48 h、术后72 h的VAS评分低于TLIF组（P < 0.05）；术后3、6个月腰痛、下肢痛VAS评分及术后6个月椎间隙高度、腰椎前凸角、硬膜囊横断面积、椎间孔面积高于术前，但组间比较差异无统计学意义（P > 0.05）；2组功能预后优良率（98.04%、94.12%）比较，差异无统计学意义（P > 0.05）；VBE组无并发症发生，TLIF组1例出现切口渗出。 结论 VBE与TLIF治疗LDH伴腰椎不稳患者，可增强腰椎稳定性，改善患者腰椎功能，确保安全性，而VBE切口小，可减少术中出血，降低术后早期疼痛，加快早期病情恢复。 Abstract:Objective To compare the effectiveness of V-shaped double-channel spine endoscope technology （VBE） in treating lumbar disc herniation （LDH） with lumbar instability with traditional transforaminal lumbar interbody fusion （TLIF）. Methods From January 2021 to March 2023, 102 patients with LDH and lumbar instability admitted to the People's Hospital of Guandu District, Kunming City, and the Tenth People's Hospital of Shanghai were selected. They were randomly divided into two groups using random grouping software: the TLIF group （undergoing TLIF surgery, n = 51） and the VBE group （undergoing VBE surgery, n = 51）. The two groups were compared in terms of general surgical conditions, perioperative pain levels （VAS scores）, pre- and postoperative levels of back and leg pain （VAS scores）, lumbar spine stability （intervertebral height, lumbar lordosis angle）, decompression effect （cross-sectional area of the dural sac, intervertebral foramina area）, functional prognosis, and complication status. Results In the VBE group, the amount of bleeding during the surgery was less than in the TLIF group, with shorter incision length, bed rest time, and hospital stay compared to the TLIF group （P < 0.05）. VAS scores at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours post-operation were lower in the VBE group compared to the TLIF group （P < 0.05）. VAS scores for lower back pain and leg pain at 3 and 6 months post-operation, as well as intervertebral height, lumbar lordosis angle, dural sac cross-sectional area, and intervertebral foramen area at 6 months post-operation were higher than pre-operation levels in both groups, but the inter-group differences were not statistically significant （P > 0.05）. Comparison of the excellent-to-good functional prognosis rates between the two groups （98.04%, 94.12%） showed no statistically significant difference （P > 0.05）. no complications occurred in the VBE group, while one case of incision exudation occurred in the TLIF group. Conclusion VBE and TLIF treatment for LDH with lumbar instability patients can enhance lumbar stability, improve patients' lumbar function, ensure safety, while VBE with a small incision can reduce intraoperative bleeding, decrease early postoperative pain, and speed up early recovery. -
图 1 VBE手术前后影像图片
A：术前俯卧位X线正位片；B：腰椎横截面CT影像片；C：术后俯卧位X线正位片。
Figure 1. Images before and after VBE surgery
图 2 TLIF手术前后影像图片
A：术前俯卧位X线正位片；B：腰椎横截面CT影像片；C：术后俯卧位X线正位片。
Figure 2. Images of TLIF before and after surgery
表 1 2组基线资料比较[（$\bar x \pm s $）/n（%）]
Table 1. Comparison of baseline information between the two groups [（$\bar x \pm s $）/n （%）]
基线资料 VBE组（n=51） TLIF组（n=51） χ2/t P 年龄（岁） 65.14±3.42 64.97±3.48 0.359b 0.720 性别 0.630a 0.428 男 29（56.86） 25（49.02） 女 22（43.14） 26（50.98） BMI（kg/m2） 22.98±1.61 23.22±1.58 1.099b 0.273 病程（a） 3.79±1.28 3.92±1.31 0.731b 0.465 病变椎体 0.531 0.767 L3/4 10（19.61） 8（15.69） L4/5 27（52.94） 26（50.98） L5/S1 14（27.45） 17（33.33） 病变类型 0.371a 0.831 侧型 23（45.10） 20（39.22） 中央型 15（29.41） 17（33.33） 中央旁型 13（25.49） 14（27.45） 髓核突出程度 1.131a 0.568 隆起型 25（49.02） 22（43.14） 破裂型 14（27.45） 19（37.25） 游离型 12（27.45） 10（19.61） 合并症 高血压 21（41.18） 18（35.29） 0.374a 0.541 糖尿病 5（9.80） 8（15.69） 0.793a 0.373 高脂血症 7（13.73） 9（17.65） 0.297a 0.586 a表示χ2检验；b表示t检验。 
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表 2 2组手术一般情况比较[$ \bar x \pm s $/M（P25，P75）]
Table 2. Comparison of general surgical conditions in the two groups [（$\bar x \pm s $）/M（P25，P75）]
组别 n 切口长度（cm） 手术时间（min） 术中出血量（mL） X线透视次数（次） 卧床时间（d） 住院时间（d） VBE组 51 1.01±0.23 101.67±14.39 41.70±13.52 6（3，9） 2.24±0.57 7.00±2.12 TLIF组 51 2.45±0.76 99.50±12.44 80.44±21.68 7（4，10） 4.00±0.81 10.52±3.11 t/Mann-Whitney U 17.830 1.187 15.241 0.954 17.968 9.441 P <0.001* 0.236 <0.001* 0.231 <0.001* <0.001* *P < 0.05。
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表 3 2组围手术期VAS评分比较（$\bar x \pm s $，分）
Table 3. Comparison of perioperative VAS scores in the two groups （$\bar x \pm s $，scores）
组别 n 术前 术后6 h 术后12 h 术后24 h 术后48 h 术后72 h VBE组 51 7.02±2.29 2.25±0.70 1.77±0.46 1.21±0.33 0.81±0.25 0.64±0.23 TLIF组 51 6.95±2.30 3.40±0.68 2.89±0.55 2.40±0.59 1.56±0.40 1.19±0.32 t 0.222 12.179 15.945 17.609 15.984 14.128 P 0.824 <0.001* <0.001* <0.001* <0.001* <0.001* *P < 0.05。
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表 4 2组腰痛与下肢痛VAS评分比较（$\bar x \pm s $，分）
Table 4. Comparison of VAS scores for low back pain and lower extremity pain in the two groups （$\bar x \pm s $，scores）
指标 组别 n 术前 术后3个月 术后6个月 腰痛VAS评分（分） VBE组 51 7.02±2.29 1.18±0.39 0.55±0.17 TLIF组 51 6.95±2.30 1.26±0.35 0.59±0.18 t 0.154 −1.090 −1.154 P 0.878 0.278 0.251 下肢痛VAS评分（分） VBE组 51 6.12±2.00 1.44±0.32 1.09±0.25 TLIF组 51 5.90±1.87 1.51±0.30 1.14±0.21 t 0.574 −1.140 −1.094 P 0.567 0.257 0.277
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表 5 2组腰椎稳定性比较（$\bar x \pm s $）
Table 5. Comparison of lumbar spine stability between the two groups （$\bar x \pm s $）
组别 n 椎间隙高度（mm） t P 腰椎前凸角（°） t P 术前 术后6个月 术前 术后6个月 VBE组 51 6.52±1.36 11.52±1.44 25.953 <0.001* 45.83±9.11 55.10±8.64 7.642 <0.001* TLIF组 51 6.60±1.28 11.40±1.59 23.952 <0.001* 46.78±7.52 54.28±10.01 6.078 <0.001* t 0.444 0.574 0.839 0.634 P 0.658 0.568 0.402 0.527 *P < 0.05。
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表 6 2组减压效果比较[（$\bar x \pm s $），mm2]
Table 6. Comparison of the effect of decompression in the two groups [（$\bar x \pm s $），mm2]
组别 n 椎间孔面积 t P 硬膜囊横断面积 t P 术前 术后6个月 术前 术后6个月 VBE组 51 136.58±22.73 160.33±29.84 6.429 <0.001* 79.13±24.56 113.67±19.53 11.515 <0.001* TLIF组 51 138.00±24.15 158.95±26.00 6.064 <0.001* 81.27±27.40 111.06±22.77 8.724 <0.001* t 0.440 0.363 0.596 0.889 P 0.660 0.717 0.552 0.374 *P < 0.05。
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表 7 2组功能预后比较[n（%）]
Table 7. Comparison of functional prognosis between the two groups [n （%）]
组别 n 优 良 一般 差 优良率 VBE组 51 39（76.47） 11（21.57） 1（1.96） 0（0.00） 50（98.04） TLIF组 51 32（62.75） 16（31.37） 3（5.88） 0（0.00） 48（94.12） χ2 0.260 P 0.610
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