【摘要】 目的：探讨侧入路双通道法经皮内镜下髓核摘除术治疗高度游离型腰椎间盘突出症（lumbar dics herniation,LDH）的临床疗效。方法：回顾性分析2021年1月至2022年12月采用脊柱内镜技术治疗高度游离型LDH患者54例，采用侧入路双通道法经皮内镜下髓核摘除术治疗27例（侧入路双通道组），男16例，女11例，年龄（54.6±10.5）岁；采用单侧双通道内镜（unilateral biportal endoscopy,UBE）手术治疗27例（UBE组），男17例，女10例，年龄（52.9±12.3）岁。观察比较两组术中透视次数、手术时间、住院时间，以及术前、术后1 d及1、3、12个月腰腿痛视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数评分（Oswestry diability index,ODI），采用改良MacNab标准进行临床疗效评价。结果：54例患者均顺利完成手术治疗，且获得随访，时间12～22(13.57±4.12)个月。两组手术时间比较，差异无统计学意义（P>0.05）。侧入路双通道组住院时间（3.9±1.1） d，少于UBE组（6.5±1.4） d；侧入路双通道组术中透视次数（12.7±2.1）次，多于UBE组（6.6±1.3）次；差异均有统计学意义（t=5.197、-7.532,P均<0.05）。侧入路双通道组术后1 d、1个月腰痛VAS及ODI、术后1 d腿痛VAS均优于UBE组，差异均有统计学意义（P<0.05）；而术前及术后3、12个月两组腰腿痛VAS和ODI比较差异均无统计学意义（P>0.05）；术后12个月根据改良MacNab标准，两组优良率分别为92.6%(25/27)和88.9%(24/27)，差异无统计学意义（χ~2=0.22,P>0.05）。结论：对于高度游离型LDH患者，侧入路双通道法和UBE内镜下手术都是安全有效的。侧入路双通道法经皮内镜下手术可在局部麻醉下完成，能够直视下摘除髓核，更简单高效。更多还原

【Abstract】 Objective To explore clinical efficacy of percutaneous endoscopic discectomy with a lateral approach and dual channel method in treating highly free lumbar disc herniation(LDH). Methods A retrospective analysis was conducted on 54 patients with highly free LDH who were treated with spinal endoscopic techniques from January 2021 to December 2022.Twenty seven patients were treated with lateral approach dual-channel(lateral approach dual channel group),including 16 males and 11 females,with an average age of(54.6±10.5) years old. Twenty seven patients were treated with unilateral biportal endoscopic(UBE group),including 17 males and 10 females,with an average age of(52.9±12.3) years old. The number of intraoperative fluoroscopy,operation time and hospital stay,as well as visual analogue scale(VAS) and Oswestry diability index(ODI) of low back and leg pain between two patients before operation,1 day,1,3,and 12 months after operation,and the efficacy was evaluated by the modified MacNab criteria at 12 mohths after operation. Results All patients were successfully completed surgical and were followed up,the time raged from 12 to 22 months with an average of(13.57±4.12) months. There was no statistically significant difference in operation time between two groups(P>0.05). The hospital stay of lateral approach dual channel group was(3.9±1.1) days,which was shorter than that of UBE group(6.5±1.4) days,the number of intraoperative fluoroscopy in lateral approach dual channel group was(12.7±2.1) times,which was more than that in UBE group(6.6±1.3)times,the differences were statistically significant(t=5.197,-7.532;P<0.05). VAS and ODI for low back pain at 1 day and 1 month after operation,and VAS for leg pain at 1 day after operation of lateral approach dual channel group were superior to those of UBE group,and the differences were statistically significant(P<0.05). However,there were no statistically significant differences in VAS and ODI for low back and leg pain between two groups before operation and 3 and 12 months after operation(P>0.05). VAS and ODI of low back and leg pain were significantly improved at each time point before and after operation in both groups,and the difference were statistically significant(P<0.05). At 12 months after operation,according to the modified MacNab criteria,the excellent and good rates of therapeutic effects between lateral approach dual channel group and UBE group were 92.6%(25/27) and 88.9%(24/27),respectively,and the difference was not statistically significant （χ~2=0.22,P>0.05）. Conclusion For patients with highly free lumbar intervertebral disc protrusion,both of lateral approach dual channel method and UBE endoscopic surgery are safe and effective. Endoscopic surgery with lateral approach and dual channel method could be performed under local anesthesia,allowing for the removal of the nucleus pulposus under direct vision. It is simpler,more efficient.更多还原