单侧双通道内窥镜技术与经皮内窥镜下腰椎椎间盘切除术治疗单节段腰椎椎间盘突出症的早期疗效比较

目的 对比单侧双通道内窥镜（UBE）技术与经皮内窥镜下腰椎椎间盘切除术（PELD）治疗单节段腰椎椎间盘突出症（LDH）的早期临床疗效。方法 回顾性分析2020年10月—2021年4月接受手术治疗的77例单节段LDH患者临床资料，其中采用UBE技术治疗30例（UBE组），采用PELD治疗47例（PELD组）。记录2组手术时间、术中出血量、透视次数、住院时间及并发症发生情况。术前及术后1、3、6、12个月和末次随访时采用疼痛视觉模拟量表（VAS）评分评估腰腿痛程度，采用Oswestry功能障碍指数（ODI）评估腰椎功能。末次随访时采用改良MacNab标准评价临床疗效。结果 所有手术顺利完成，患者随访> 12个月。UBE组手术时间长于PELD组，术中出血量、透视次数少于PELD组，差异均有统计学意义（P < 0.05）。2组患者术后腰腿痛VAS评分及ODI较术前显著改善，差异均有统计学意义（P < 0.05）。UBE组术后1、3、6个月的腰痛VAS评分高于PELD组，差异均有统计学意义（P < 0.05）。2组术后各随访时间点腿痛VAS评分、ODI组间差异无统计学意义（P > 0.05）。末次随访时按照改良MacNab标准，UBE组疗效优良率为90.0%，PELD组为89.4%，差异无统计学意义（P > 0.05）。UBE组发生术中硬膜撕裂2例，术后复发2例；PELD术后复发1例。 结论 UBE和PELD治疗单节段LDH均可获得良好的早期临床疗效，各有优势，UBE适应证更广泛，学习曲线平缓；PELD创伤更小，患者术后早期腰痛程度更轻。

Early efficacy of unilateral biportal endoscopic technique versus percutaneous endoscopic lumbar discectomy for treatment of single-segment lumbar disc herniation

Objective To compare the early efficacy of unilateral biportal endoscopy(UBE) technique and percutaneous endoscopic lumbar discectomy(PELD) in the treatment of single-segment lumbar disc herniation(LDH). Methods From October 2020 to April 2021,the clinical data of 77 patients with single-segment LDH who received surgical treatment were retrospectively analyzed,including 30 treated with UBE technique(UBE group) and 47 with PELD(PELD group). The operation time,intraoperative blood loss,fluoroscopy frequency,hospital stay and complications were recorded in the 2 groups. The visual analog scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the intensity of low back and leg pain and lumbar function at pre-operation,postoperative 1,3,6,12 months and the final follow-up. The modified MacNab criteria was used to evaluate the clinical efficacy at the final follow-up. Results All the operations were successfully completed,and the patients were followed up for more than 12 months. The operation time in the UBE group was longer than that in the PELD group,the intraoperative blood loss and fluoroscopy frequency were less than those in the PELD group,all with a significant difference(P < 0.05). The VAS scores of low back and leg pain and ODI of the 2 groups after operation were significantly improved compared with those before operation,all with a significant difference(P < 0.05). The VAS scores of low back pain in the UBE group at postoperative 1,3,6 months were higher than those in the PELD group,and the differences were statistically significant(P < 0.05). There was no significant difference in the VAS score of leg pain and ODI between the 2 groups at each follow-up time point(P > 0.05). At the final follow-up,according to the modified MacNab criteria,the excellent and good rate of efficacy was 90.0% in the UBE group and 89.4% in the PELD group,and there was no statistical significance between the 2 groups(P > 0.05). In the UBE group,intraoperative dural tear occurred in 2 cases,postoperative recurrence in 1;in the PELD group,there was postoperative recurrence in 1. Conclusions Both UBE and PELD can achieve good early clinical efficacy in the treatment of single-segment LDH,and each has its own advantages. UBE has more extensive indications,and a smooth learning curve;PELD has less trauma and less early postoperative low back pain.