杭州市中医院 脊柱微创中心，浙江 杭州 310007
Department of Spine Minimally Invasive Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang 310007, China
目的 探讨单边双通道内镜（UBE）技术治疗高位腰椎间盘突出症（ULDH）的临床疗效。方法 回顾性分析2020年1月－2021年12月采用UBE治疗ULDH的28例患者的临床资料。记录并分析内镜下手术时间、术后引流量、术后住院时间和相关并发症，根据术前、术后1周、术后1个月、术后3个月和末次随访时的Oswestry功能障碍指数（ODI）、腰部和下肢的疼痛视觉模拟评分（VAS）、改良MacNab评分，评估临床疗效。结果 所有患者均在内镜下完成手术。非融合单间隙手术时间（47.50±11.84）min，双间隙手术时间（75.00±20.66）min，融合手术时间（77.50±21.02）min；非融合单间隙术后引流量（25.00±13.94）mL，双间隙术后引流量（38.00±11.83）mL，融合术后引流量（71.25±31.72）mL。术后住院时间（8.28±4.22）d，术后随访时间（15.82±4.54）个月。手术前后ODI和VAS比较，差异均有统计学意义（P < 0.05）。末次随访时，根据改良的MacNab评分标准，优良率为96.43%。术后2例患者出现下肢麻木和疼痛不适，无活动障碍，经保守治疗后恢复。结论 UBE治疗ULDH的临床疗效较好，根据病情需要，选用腰椎板间入路或椎旁入路，可在治疗疾病的同时，达到微创的目的，且无需准备特殊的器械，值得临床推广应用。
Objective To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) technique in treatment of upper lumbar disc herniation (ULDH).Methods Clinical data of 28 ULDH patients treated with UBE from January 2020 to December 2021 were retrospectively analyzed. The operation time under endoscopy, postoperative drainage, postoperative hospital stay and complications were recorded and analyzed. The clinical efficacy was evaluated according to the modified MacNab score, Oswestry disability index (ODI) and visual analogue scale (VAS) of low back pain and lower limb pain at pre-operation, 1 week, 1 month, 3 months after operation and the last follow-up.Results All the patients completed the endoscopic operation successfully. Operation time under endoscopy of non fusion were (47.50 ± 11.84) min in monosegment and (75.00 ± 20.66) min in two segments, while fusion was (77.50 ± 21.02) min. Postoperative drainage of non fusion were (25.00 ± 13.94) mL in monosegment and (38.00 ± 11.83) mL in two segments, while there was (71.25 ± 31.72) mL in fusion cases, respectively. Postoperative hospital stay was (8.28 ± 4.22) d, the follow-up time was (15.82 ± 4.54) months. There was statistical significance in ODI and VAS before and after operation (P < 0.05). According to the modified MacNab scoring standard, the ratio of excellent and good was 96.43% at the last follow-up. There were 2 cases with transient numbness and pain of lower limbs and no activity disorder after operation, and they all recovered after conservative treatment.Conclusion The clinical effect of UBE technique in the treatment of ULDH is reliable. According to the needs of the disease, the interlaminar approach or paravertebral approach of UBE technique can be selected. It takes into account the effect of treating diseases, achieves the purpose of minimally invasive, and does not need to prepare special instruments. It is worthy of clinical application.