[1]周奕洁赵加庆李吉琛耿晓鹏付国勇**.单侧双通道内镜技术治疗L5/S1极外侧腰椎间盘突出症合并同侧L4/5侧隐窝狭窄[J].中国微创外科杂志,2026,01(4):206-211.
　Zhou Yijie,Zhao Jiaqing,Li Jichen,et al.Unilateral Biportal Endoscopy in the Treatment of Far Lateral Lumbar Disc Herniation at L5/S1 Combined With Ipsilateral L4/5 Lateral Recess Stenosis[J].Chinese Journal of Minimally Invasive Surgery,2026,01(4):206-211.
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单侧双通道内镜技术治疗L5/S1极外侧腰椎间盘突出症合并同侧L4/5侧隐窝狭窄()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年4期
页码:
206-211
栏目:
临床研究
出版日期:
2026-04-24

文章信息/Info

Title:
Unilateral Biportal Endoscopy in the Treatment of Far Lateral Lumbar Disc Herniation at L5/S1 Combined With Ipsilateral L4/5 Lateral Recess Stenosis
作者:
周奕洁赵加庆李吉琛耿晓鹏付国勇**
(滨州医学院附属医院脊柱外科，滨州256603)
Author(s):
Zhou Yijie;  Zhao Jiaqing;  Li Jichen;  et al.
Department of Spinal Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou 256603, China
关键词:
极外侧腰椎间盘突出症; 单侧双通道内镜技术; 侧隐窝狭窄
Keywords:
Far lateral lumbar disc herniation; Unilateral biportal endoscopy; Lateral recess stenosis
文献标志码:
A
摘要:
目的探究单侧双通道内镜技术(unilateral biportal endoscopy, UBE)治疗L5/S1极外侧腰椎间盘突出症(far lateral lumbar disc herniation，FLLDH)合并同侧L4/5侧隐窝狭窄的临床疗效。方法2022年1月~2023年12月采用UBE治疗21例L5/S1 FLLDH合并同侧L4/5侧隐窝狭窄。取俯卧位，以L4椎体棘突根部为中心，旁开中线约1.5 cm，上下距离为 1.5 cm 各做一纵行1 cm切口，内镜直视下完成侧隐窝减压和L5神经根松解；L5棘突同侧旁开3.5~4 cm，L5椎弓根下缘水平上下距离为 1.5 cm 各做一纵行1 cm切口，内镜直视下L5/S1椎间孔区域松解神经根，切除位于出口根下方及腋部椎间孔区域突出的椎间盘组织。结果21例顺利完成手术，无严重并发症发生。手术时间(125.8±12.6)min；透视次数(5.4±13)次；术中出血量(21.8±4.8)ml；住院时间(6.3±1.1)d。与术前比较，出院时、术后3个月腰痛视觉模拟评分（Visual Analogue Scale,VAS)［(5.1±1.1)分 vs. (2.9±0.7)分，P=0.000；(5.1±1.1)分vs.(1.6±0.5)分，P=0.000］和下肢疼痛VAS评分［7.0(5.5,70)分vs.3.0(15,3.0)分，P=0.000；7.0(5.5,7.0)分vs.1.0(0.0,10)分,P=0.000］均显著降低。出院时、术后3个月Oswestry功能障碍指数(Oswestry Disability Index，ODI)显著低于术前［(56.8±3.4)%vs.(14.2±24)%，P=0.000；(56.8±3.4)%vs.(2.4±11)%，P=0.000］。与术前相比，出院时、术后3个月直腿抬高角度显著增加(34.1°±4.4° vs. 58.6°±5.5°，P=0.000；341°±4.4° vs. 74.0°±6.6°，P=0.000)；与术前比较，出院时、术后3个月患侧趾背伸肌力亦显著改善(χ2=37.284，P=0000)。术前间歇性跛行距离为(78.8±18.4)m，术后3个月时所有患者步行500 m均未出现症状。影像学评估显示，出院时L4/5椎管面积［(0.9±0.2)cm2 vs.(1.5±0.2)cm2, P=0.000］与患侧侧隐窝矢状径［(2.6±0.2)mm vs.(6.0±0.4)mm, P=0.000］较术前均显著增大。术后关节突关节保留率L4/5为(77.3±3.8)%，L5/S1为(82.2±3.4)%。21例随访(12.1±14)月。末次随访改良MacNab疗效标准：优16例，良3例，可2例，优良率90.5%(19/21)。结论UBE治疗L5/S1 FLLDH合并同侧L4/5侧隐窝狭窄近期临床效果良好。
Abstract:
ObjectiveTo explore the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of far lateral lumbar disc herniation (FLLDH) at L5/S1 combined with lateral recess stenosis at L4/5 on the same side.MethodsFrom January 2022 to December 2023, our department used UBE to treat 21 patients with L5/S1 FLLDH combined with ipsilateral L4/5 lateral recess stenosis. The patients were placed in the prone position. Centered on the root of the L4 vertebral spinous process, approximately 1.5 cm lateral to the midline, two 1 cm longitudinal incisions were made with an upperlower distance of 1.5 cm. After stepwise cannula dilation of the soft tissue, lateral recess decompression and L5 nerve root release were completed under direct endoscopic vision. On the same side of the L5 spinous process at 3.5-4 cm lateral direction, at the level of the lower edge of the L5 pedicle, two 1 cm longitudinal incisions were made with an upperlower distance of 1.5 cm. After stepwise cannula dilation of the soft tissue, under direct endoscopic vision in the L5/S1 foramen region, the nerve root was released, and the herniated disc material located below the exiting root and in the axillary foraminal area was removed. Preoperative and postoperative lower limb pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the MacNab criteria at the final followup were compared to evaluate surgical efficacy.ResultsAll the 21 cases successfully received the surgery, with no severe complications. The operation time was (125.8±12.6)min, the fluoroscopy times were (5.4±1.3)times, the intraoperative blood loss was (21.8±4.8)ml, and the hospitalization time was (6.3±1.1)d. Compared with preoperation, the low back pain VAS scores at discharge and 3 months postoperatively were significantly lower ［(5.1±1.1)points vs. (2.9±0.7)points, P=0.000; (5.1±1.1)points vs.(1.6±0.5)points, P=0.000］, and the lower limb pain VAS scores were also significantly lower ［7.0 (5.5, 7.0)points vs. 3.0 (1.5, 3.0)points, P=0.000; 70 (5.5, 7.0) points vs. 1.0 (0.0, 1.0)points, P=0.000］. The ODI at discharge and 3 months postoperatively was significantly lower than preoperative ［(56.8±3.4)% vs. (14.2±2.4)%, P=0.000; (56.8±3.4)% vs. (2.4±1.1)%, P=0.000］. Compared with preoperation, the straight leg raising angle significantly increased at discharge and 3 months postoperatively (34.1°±44° vs. 58.6°±5.5°, P=0.000; 34.1°±4.4° vs. 74.0°±6.6°, P=0.000), and the great toe extension strength was also significantly improved (χ2=37.284, P=0.000). The preoperative intermittent claudication distance was (78.8±18.4)m, and all the patients were able to walk 500 m without symptoms at 3 months postoperatively. Imaging assessment showed the L4/5 spinal canal area ［(0.9±0.2)cm2 vs. (1.5±0.2)cm2, P=0.000］ and the sagittal diameter of the affected lateral recess ［(2.6±0.2)mm vs. (6.0±0.4)mm, P=0000］ at discharge were significantly larger than preoperation. The postoperative facet joint preservation rate was (77.3±3.8)% at L4/5 and (82.2±3.4)% at L5/S1. The 21 cases were followed up for (12.1±1.4) months. At the final followup, according to the modified MacNab criteria, there were excellent in 16 cases, good in 3 cases, and fair in 2 cases, with an excellentandgood rate of 90.5%(19/21).ConclusionUBE is a minimally invasive technique with good clinical efficacy in the treatment of L5/S1 FLLDH combined with L4/5 lateral recess stenosis on the same side.

参考文献/References:

[1]Abdullah AF, Ditto EW 3rd, Byrd EB, et al. Extremelateral lumbar disc herniations. Clinical syndrome and special problems of diagnosis. J Neurosurg,1974,41(2):229-234.
[2]Lin L, Ke ZY, Chu L, et al. Fullendoscopic lumbar discectomy via lateral superior articular process approach for treating far lateral lumbar disc herniation: a retrospective study an technical note. Int Orthop,2023,47(11):2843-2850.
[3]赵景文,吕超亮,张存鑫,等.单侧双通道内镜下远外侧入路治疗腰椎椎间孔狭窄症39例报告.中国微创外科杂志,2025,25(6):354-359.
[4]Shafiekhani P, HajimohammadebrahimKetabforoush M, Jajin EA, et al. Clinical outcomes following decompression of central canal and lateral recess simultaneous stenosis, with a focus on multilevel stenosis: A randomized comparison of microscopic bilateral laminotomy versus total laminectomy with posterior spinal fusion. World Neurosurg,2024,187:e257-e263.
[5]Webb CW, Aguirre K, Seidenberg PH. Lumbar spinal stenosis: Diagnosis and management. Am Fam Physician,2024,109(4):350-359.
[6]刘璐,张希诺,康南.单侧双通道脊柱内镜技术的应用现状及思考.中国修复重建外科杂志,2024,38(12):1510-1516.
[7]舒涛,吴帝求,滕飞,等.单侧双通道脊柱内镜技术对侧椎板下入路治疗腰椎侧隐窝狭窄合并同节段椎间孔狭窄的早期疗效.中国修复重建外科杂志,2024,38(7):874-879.
[8]张先鹏,何泽伟,楼钰晗,等.单侧双通道内镜椎旁入路治疗极外侧型腰椎间盘突出症的临床疗效.中国内镜杂志,2023,29(12):1-7.
[9]Lai PL, Chen LH, Niu CC, et al. Effect of postoperative lumbar sagittal alignment on the development of adjacent instability. J Spinal Disord Tech,2004,17(5):353-357.
[10]Raco A, Pesce A, Fraschetti F, et al. Motor outcomes after surgical resection of lesions involving the motor pathway: A prognostic evaluation scale. World Neurosurg，2017,103:748-756.
[11]Le H，Sandhu FA，Fessler RG.Clinical outcomes after minimal access surgery for recurrent lumbar disc herniation.Neurosurg Focus,2003,15(3):E12.
[12]于先凯,赵加庆,任佳彬,等.单侧双通道内镜技术治疗腰椎管狭窄症合并退行性脊柱侧弯的2种入路的比较研究.中国微创外科杂志,2023,23(11):807-812.
[13]赵家贵,张荣宜,朱本藩,等.椎间孔镜技术与胶原酶溶解术治疗极外侧型(Ⅱ型)腰椎间盘突出症的疗效比较.中国疼痛医学杂志,2023,29(2):113-119.
[14]Montinaro A. The microsurgical approach to extraforaminal lumbar disc herniations. An analysis of 15 cases. J Neurosurg Sci,2004,48(1):23-28.
[15]Dogu H, Ozdemir NG, Yilmaz H, et al. Longterm followup results of surgically treated patients with foraminal and far lateral disc herniations. Br J Neurosurg,2023,37(1):49-52.
[16]王元,殷世武.极外侧型腰椎间盘突出症的治疗进展.介入放射学杂志,2015,24(10):928-931.
[17]Connolly J, Borja AJ, Kvint S, et al. Postoperative outcomes and resource utilization following open vs endoscopic far lateral lumbar discectomy. Int J Spine Surg,2023,17(3):350-355.
[18]郑明军,蒋臻,张植雄,等.经皮椎间孔镜技术与显微镜辅助治疗腰椎间盘突出症的临床疗效分析.中国内镜杂志,2023,29(4):13-18.
[19]Zhiqiang Z, Jiandong Y, Zhi H, et al. Clinical efficacy of biportal versus uniportal endoscopic discectomy for far lateral lumbar disc herniation: A retrospective study analysis. World Neurosurg,2025,197:123788.
[20]Soliman HM. Irrigation endoscopic discectomy: A novel percutaneous approach for lumbar discprolapse. Eur Spine J,2013,22(5):1037-1044.
[21]Jiang HW, Chen CD, Zhan BS, et al. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res,2022,17(1):30.
[22]Kerr HL, Wadikhaye R, Sun GU, et al. Paramedian unilateral ‘bitubular’ endoscopic access for a far lateral disc herniation: A novel approach for far lateral lumbar pathologies. Neurospine, 2024,21(4):1160-1167.
[23]高磊磊,刘俊,黄晓夏,等.选择性神经根阻滞术治疗腰骶神经根病的研究进展.协和医学杂志,2025,16(3):739-748.
[24]胡震,杨阳,赵树雄,等.单侧双通道内镜技术的临床应用与展望.解放军医学杂志,2024,49(3):349-354.
[25]卓灿,刘扬,张钰裙,等.UBE治疗极外侧型腰椎间盘突出症并发腹腔积水1例报道.实用骨科杂志,2024,30(9):855-857.

备注/Memo

备注/Memo:
基金项目：山东省自然科学基金资助项目（ZR2017LH020）**通讯作者，Email：464202890@qq.com
更新日期/Last Update: 2026-04-24