| Objective:To investigate and compare the respective advantages and disadvantages of three posterior spinal endoscopic techniques of discoscopic discectomy(MED)and percutaneous interlaminar approach endoscopic nucleus pulposus removal(PEID)and unilateral dual-channel spinal endoscopic technique(UBE)for the treatment of free lumbar disc herniation and their respective advantages and disadvantages of clinical efficacy,and to provide reference for clinical application.Methods:The data of 78 patients with free lumbar disc herniation who underwent surgical treatment at the China-Japan Union Hospital of Jilin University from January 2012 to January 2022 were retrospectively analyzed and divided into MED group(33 patients),PEID group(27patients),and UBE group(18 patients)according to their surgical procedures,comparing the general data of the three groups such as gender,age,disease duration,lesion segments,etc.,operative time,intraoperative We compared the general data of the three groups,such as gender,age,lesion segment,intraoperative bleeding(total amount of fluid in the collection bucket-total amount of saline for rinsing),intraoperative X-ray exposure,incision length,postoperative bed rest time and other perioperative indicators,the visual analog scale(VAS)efficacy indicators of low back pain before surgery,3 days after surgery,1,3 and 6 months after surgery,and the Oswestry disability index(OD index)of the three groups.Oswestry disability index(ODI),modified Macnab criteria at 1 year postoperatively,and complications(intraoperative macrovascular injury,nerve root injury(lower extremity sensorimotor abnormalities),poor surgical incision healing,periwound tissue edema,intervertebral space infection,epidural hematoma,and dural tear)in all three groups,and MRI was performed to assess the improvement of imaging as well as the measurement data of CT three-dimensional reconstruction to assess the degree of bone destruction of the vertebral plate for the three procedures.Results:A total of 78 patients,including 41 male and 37 female patients,with a mean age of 40.1±4.2 years and a mean disease duration of9.2±3.3 months,completed surgery in the MED,PEID,and UBE groups,with no statistically significant differences between the three groups in terms of gender,age,disease duration,or lesion segment location(P>0.05).The VAS scores of the three groups at 3 days,1 month,3months and 6 months postoperatively were(2.5±0.7,2.2±0.4,1.8±0.4,1.5±0.5;2.4±0.7,2.0±0.6,1.7±0.5,1.4±0.5;2.4±0.8,2.1±0.6,1.8±0.6,1.4±0.5),respectively,compared with the preoperative VAS scores(6.2±0.9,5.9±0.7,5.8±0.7)were significantly lower(P<0.05).The ODI indices of the three groups at 3 days,1 month,3 months and 6 months postoperatively were(30.8±4.2,26.1±2.0,20.8±3.0,15.6±1.7;30.0±3.4,25.4±1.5,19.8±2.2,16.4±2.3;30.2±1.8,24.9±1.4,19.6±2.5,respectively14.6±5.4),which was significantly lower(P<0.05)than the preoperative ODI index(58.4±3.7,59.1±3.1,60.1±1.8),and the modified Macnab criteria for the three groups at 1 year postoperatively were,in the MED group: excellent 22 cases,good 9 cases,acceptable 1 case,poor 1 case,whose excellent rate was 93.9%;in the PEID group: excellent 18 cases,good 7 cases,In the PEID group: excellent in 18 cases,good in 7 cases,acceptable in 1 case,poor in 1 case,with an excellent rate of 92.6%.In the UBE group: 12 cases were excellent,5 cases were good,1case was acceptable,and 0 cases were poor,with an excellent rate of94.4%,and there was no significant difference in the excellent rate between the three groups(P > 0.05).Comparison of perioperative parameters among the three groups: postoperative bed rest time in the MED group was 5.2±0.9 d longer than that in the UBE group 2.2±0.4 d and PEID 2.3±0.5 d(P < 0.05);intraoperative bleeding in the MED group was 60.7±9.2 ml more than that in the UBE group 48.4±8.5 ml and PEID group 43.1±8.0 ml(P < 0.05);PEID group The surgical incision length of 7.1±0.5 mm was smaller than that of 25.3±1.1 mm in the UBE group and 18.2±0.9 mm in the MED group(P<0.05);the operating time of 60.7±8.5 min in the MED group was shorter than that of 100.7±10.2 min in the PEID group and 120.7±11.9 min in the UBE group(P<0.05);the number of intraoperative fluoroscopy in the MED group The number of intraoperative fluoroscopy in the MED group was2.2±0.4 times less than 3.6±0.5 times in the PEID group and 3.8±0.7times in the UBE group(P<0.05).There was no statistical difference in the incidence of postoperative complications among the three groups(P>0.05),among which 2 cases of postoperative lower limb dyskinesia occurred in the UBE and PEID groups,which were considered to be caused by the surgical stretching of the nerve and the high hydrostatic pressure of the irrigation fluid and long irrigation time,and the symptoms basically disappeared 5 days after the operation after routine anti-inflammatory and nerve nutrition treatment.The symptoms gradually improved after routine dressing change and other operations.There was one case of dural tear in each of the three groups,and no cerebrospinal fluid leakage occurred after the operation with depillowing.2 cases of periwound tissue edema occurred in both the PEID and UBE groups,which were considered to be related to prolonged intraoperative aqueous media operation.2 cases of postoperative intervertebral space infection occurred in the MED group.The remaining complications of large vessel injury and epidural hematoma did not occur in any of the three groups.Conclusions:1.Comparison of efficacy: the three posterior spinal endoscopic techniques showed significant improvement in efficacy after surgery compared with the preoperative period,and there was little difference between the three groups in terms of near and long-term efficacy after surgery.2.Technical comparison.(1)MED technique is air-mediated,with a fixed channel and a narrower operating range,but with high efficiency and the shortest operative time using traditional surgical tools.(2)PEID technology is aqueous medium,complicated operation and low surgical efficiency.However,small incision,fine surgical tools,slim and flexible lens tube,and large range of movement of the working channel under the mirror.(3)UBE technique is aqueous medium,clear vision,double incision,high efficiency with traditional surgical tools,but complex operation,long operation time,and large soft tissue damage.3.Complication comparison: there is no significant difference in complications among the three groups,and the probability of complications is higher in the initial stage than in the later stage in the case of unskilled techniques. |
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