2026 年第 3 期 第 21 卷

单侧双通道内镜与经皮椎间孔镜治疗脱垂游离型腰椎间盘突出症的临床效果及安全性比较

Comparison of clinical efficacy and safety between unilateral biportal endoscopy and percutaneous endoscopic transforaminal discectomy in the treatment of prolapsed and sequestered lumbar disc herniation

作者：罗平雷杰锋胡斌邓海洋周嘉庆周煌杰胡鹏向忠杜宇轩

英文作者：Luo Ping Lei Jiefeng Hu Bin Deng Haiyang Zhou Jiaqing Zhou Huangjie Hu Peng Xiang Zhong Du Yuxuan

单位：长沙市第四医院（长沙市中西医结合医院）脊柱外科，长沙410023

英文单位：Department of Spinal Surgery the Fourth Hospital of Changsha Changsha Hospital of Integrated Chinese and Western Medicine Changsha 410023 China

关键词：腰椎间盘突出症；脱垂游离型；单侧双通道内镜；经皮椎间孔镜

英文关键词：Lumbardischerniation;Prolapsedandsequesteredtype;Unilateralbiportalendoscopy; Percutaneousendoscopictransforaminaldiscectomy

• 摘要：

• 目的 比较单侧双通道内镜技术（UBE）和经皮椎间孔镜下椎间盘切除术（PETD）治疗脱垂游离型腰椎间盘突出症的临床效果及安全性。方法 纳入2020年9月至2024年1月在长沙市第四医院接受手术治疗的脱垂游离型腰椎间盘突出症患者202例。按照接受的手术方式将患者分为2组，其中UBE组113例，PETD组89例。统计2组患者的基本临床资料，并对2组患者分别记录手术时间、术中失血量、术中X光透视次数和术后住院时间。2组患者分别进行术前和术后1 d、3个月和12个月的疼痛程度和功能恢复情况的评估，并以视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）量表对术后患者进行评估。术后第3个月及第12个月使用改良Macnab标准对患者疗效进行评估分级。记录2组患者术后并发症发生情况并进行统计学分析。结果 UBE组手术时间、术中出血量均少于PETD组［（57±10）min比（64±11）min、（29±8）ml比（36±9）ml］，差异有统计学意义(均P＜0.05)。术后3个月，UBE组优良率明显高于PETD组［84.1%(95/113)比74.2%(66/89)］，差异有统计学意义(P=0.033)。术后12个月，2组优良率比较差异无统计学意义(P=0.173)。重复测量方差分析结果提示2组VAS评分、ODI评分时间效应差异均有统计学意义(均P＜0.001)，表明整体上，患者术后疼痛随时间的延续逐渐下降，功能持续改善。UBE组术后并发症总发生率明显低于PETD组［7.1%（8/113）比18.0%（16/89）］，差异有统计学意义（P=0.038）。结论 在治疗脱垂游离型腰椎间盘突出症时，UBE具有较为理想的近期疗效及较高的手术安全度，较PETD术式更为突出。二者在长期临床疗效方面相似。

• Objective To compare the clinical efficacy and safety of unilateral biportal endoscopy (UBE) and percutaneous endoscopic transforaminal discectomy (PETD) in the treatment of prolapsed and sequestered lumbar disc herniation. Methods A total of 202 patients with prolapsed and sequestered lumbar disc herniation who underwent surgical treatment in the Fourth Hospital of Changsha from September 2020 to January 2024 were enrolled. According to the surgical method received, the patients were divided into two groups, including 113 cases in the UBE group and 89 cases in the PETD group. The basic clinical data of the two groups were collected, and the operation time, intraoperative blood loss, number of intraoperative X-ray fluoroscopies and postoperative hospital stay were recorded respectively. The pain degree and functional recovery of the two groups were evaluated before surgery as well as at 1 d, 3 months and 12 months after surgery, and the evaluation results were statistically analyzed using the visual analogue scale (VAS) score and oswestry disability index (ODI) score. The clinical efficacy of patients was evaluated and graded using the modified Macnab criteria at 3 months and 12 months after surgery. The incidence of postoperative complications in the two groups was recorded and statistically analyzed. Results The operation time and intraoperative blood loss in the UBE group were significantly less than those in the PETD group ［(57±10)min vs (64±11)min; (29±8)ml vs (36±9)ml］(both P＜0.05). At 3 months after surgery, the excellent and good rate in the UBE group was significantly higher than that in the PETD group ［84.1%(95/113) vs 74.2%(66/89)］(P=0.033). At 12 months after surgery, there was no statistically significant difference in the excellent and good rate between the two groups (P=0.173). The results of repeated measures analysis of variance showed that there were statistically significant time effects on VAS scores and ODI scores in both groups (both P＜0.001), indicating that overall, the postoperative pain of patients gradually decreased and the function continuously improved with the extension of time. The total incidence of postoperative complications in the UBE group was significantly lower than that in the PETD group ［7.1%(8/113) vs 18.0%(16/89)］(P=0.038). Conclusion In the treatment of prolapsed and sequestered lumbar disc herniation, UBE has more satisfactory short-term efficacy and higher surgical safety than PETD, while the two surgical methods have similar long-term clinical efficacy.