单、双通道脊柱内镜治疗脱垂游离型腰椎间盘突出症的临床疗效比较OA

Objective:To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)and unilateral biportal endoscopy(UBE)in the treatment of sequestered lumbar disc herniation.Method:A retrospective analysis was conducted on 46 patients with sequestered lumbar disc herniation who underwent surgical treatment in the Dongguan Tungwah Hospital between January 2023 and December 2024 and completed follow-up.Among them,26 patients underwent PELD,and 20 patients underwent UBE.The number of fluoroscopic exposures,operative time,perioperative complications,changes in hemoglobin levels,Visual Analogue Scale(VAS)scores for back and leg pain at 3 days postoperatively and at final follow-up,Oswestry Disability Index(ODI),and MacNab criteria at final follow-up were compared between the two groups.Result:All procedures were successfully completed without conversion to open surgery.In the PELD/group,one case of postoperative hematoma with residual lower limb pain improved after conservative treatment,one case of nerve root irritation caused by forceps resulted in postoperative numbness without motor deficit,and one case showed residual nucleus pulposus on imaging without clinical symptoms,requiring no further intervention.In the UBE group,one case of nerve root injury occurred due to inadvertent damage to the nerve root sheath during laminectomy,resulting in postoperative numbness without motor impairment.Two cases of asymptomatic intraspinal hematoma were observed postoperatively,which resolved spontaneously within two months.No dural tears,visceral injuries,or wound infections were reported in either group.Compared with the PELD group,the UBE group had fewer fluoroscopy sessions,but a longer operation time and a greater loss of hemoglobin after surgery than before surgery,with statistically significant differences(P<0.001).There was no statistically significant difference in the postoperative hospital stay between the two groups(P>0.05).The PELD group were followed up for(13.04±1.80)months,and the UBE group were followed up for(13.20±2.07)months.Comparisons of VAS scores,ODI,and MacNab standard excellent rates before and after surgery and at the last follow-up between the two groups showed no statistically significant differences(P>0.05).Conclusion:Both PELD and UBE techniques achieve satisfactory clinical outcomes in the treatment of sequestered lumbar disc herniation.Each technique has its own advantages and limitations,and the choice should be individualized based on surgeon expertise and patient characteristics.