关键词: 腰椎间盘突出症, 单侧双通道内镜技术, 经皮椎间孔镜下椎间盘切除术, 微创手术, 临床疗效

Abstract:

Objective To analyze the efficacies of unilateral biportal endoscopy （UBE） and percutaneous endoscopic transforaminal discectomy （PETD） in treatment of lumbar disc herniation （LDH）， and to explore the optimal selection of minimally invasive surgical approaches for the The LDH patients. Methods A retrospective analysis was performed on the clinical data of 64 LDH patients who underwent surgery at Liwan Central Hospital of Guangzhou City in Guangdong Province， between January 2020 and June 2024. The surgical approaches were determined through physician-patient communication， and the patients were divided into UBE group （n=30） and PETD group （n=34）. The materials of patients were recorded including gender， age， body mass index （BMI）， percentages of affected segments，course of disease， duration of hospitalization， operation duration， intraoperative blood loss， numbers of intraoperative fluoroscopy， total incision length， and time to full weight-bearing （WB）. The therapeutic outcomes were evaluated using Oswestry disability index （ODI）， Visual Analog Scale （VAS） scores for low back pain and leg pain， MacNab criteria， and spinal canal areas at the affected segment. the postoperative complications of the patients in two groups were analyzed. Results There were no statistically significant differences in age， gender composition ratio， BMI， course of disease， and percentages of affected segments of the patients between UBE group and PETD group （P>0.05）. Compared with PETD group， the intraoperative blood loss， total incision length， and time to full WB of the patients in UBE group were significantly increase （P<0.01）， while the number of intraoperative fluoroscopy time was decreased （P<0.01）. Compared with pre-operation， the ODI scores and VAS scores for low back and leg pain of the patients at final follow-up in both groups were decreased （P<0.01）， and the spinal canal areas at the affected segments of the patients were increased （P<0.01）. At final follow-up， compared with PETD group， the ODI score and VAS scores for low back and leg pain of patients in UBE group were decreased （P<0.01）， while the spinal canal areas at the affected segments of the patients was increased （P<0.01）. According to MacNab criteria， the percentages of excellent and good had no significant difference between two groups （P>0.05）. The incidence of complication showed no statistical difference between two groups （P>0.05）. Conclusion Both UBE and PETD yield satisfactory outcomes in the treatment of single-segment LDH. PETD is less invasive and permits earlier time to full WB， whereas UBE provides more extensive decompression and superior long-term efficacy. The surgical approach selection should be individualized based on specific factors in the clinic.

Key words: Lumbar disc herniation, Unilateral biportal endoscopy, Percutaneous endoscopic transforaminal discectomy, Minimally invasive surgery, Clinical efficacy