探究脊柱内镜下单侧入路双侧椎管减压及椎间盘切除术（Endo-ULBDD）治疗合并有中央型腰椎间盘突出的腰椎管狭窄症患者的手术技巧，评估其360°椎管减压的临床疗效、实用性及安全性。

回顾性分析2020年10月至2023年3月于青岛大学附属医院应用Endo-ULBDD技术治疗的中央型椎管狭窄合并椎间盘突出的腰椎退变患者的临床及影像学资料。共纳入62例患者，男35例，女27例，年龄56~79岁，平均（67.47±9.23）岁；椎间盘突出MSU分级均为3级，术前硬膜囊截面积（61.50±18.67）mm²；随访6~24个月，平均（14.8±5.1）个月。统计全部患者术前与术后次日、1个月、3个月及末次随访时的腰、腿痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）；测量手术前后的硬脊膜囊截面积，并计算改善率；记录手术时间，术后下地时间和出院时间。对比分析手术减压前后临床评分结果。末次随访时采用改良MacNab评分标准评定疗效。

所有患者均顺利完成手术，平均手术时间（106.67±16.43）min，术后各时间节点腰、腿痛VAS评分及ODI均较术前获得显著改善（P<0.05），术后硬脊膜囊截面积改善率为（545.6±79.72）%，根据改良MacNab疗效评定标准，优良率为93.5%。3例患者反映术后神经根支配区麻木，症状均在术后3个月内消退。无硬膜撕裂或神经根损伤等严重并发症发生，随访期内无复发病例。

Endo-ULBDD技术对合并有中央型椎间盘突出的腰椎管狭窄症患者能够实现360°减压及椎间盘切除，早期随访临床效果确切，安全性高。

To explore the surgical techniques of spinal endoscopic unilateral laminotomy for bilateral decompression and discectomy (Endo-ULBDD), and evaluate the clinical efficacy, practicability and safety of 360° spinal canal decompression for patients with lumbar spinal stenosis combined with central lumbar disc herniation.

The clinical and imaging data of patients with degenerative lumbar disease who received Endo-ULBDD at the Affiliated Hospital of Qingdao University from October 2020 to March 2023 were retrospectively analyzed. A total of 62 patients were enrolled, including 35 males and 27 females, aged 56-79 years with an average age of (67.47±9.23) years. All patients had grade 3 disc herniation according to MSU classification, and the preoperative dural sac cross-sectional area was (61.50±18.67) mm². The follow-up period ranged from 6 to 24 months, with an average of (14.8±5.1) months. The visual analogue scale (VAS) for low back and leg pain and Oswestry disability index (ODI) were recorded before surgery, on the next day after surgery, at 1 month, 3 months and the final follow-up. The cross-sectional area of dural sac was measured preoperatively and postoperatively to calculate the improvement rate. Operation duration, time to get out of bed after surgery and hospital stay were recorded. The clinical scores before and after decompression were compared and analyzed, and modified MacNab criteria were adopted to assess clinical efficacy at the last follow-up.

All patients completed the operation successfully, with a mean operative time of (106.67±16.43) min. The VAS scores of low back and leg pain as well as ODI were significantly improved at all postoperative time points compared with preoperative values (P<0.05). The improvement rate of postoperative dural sac cross-sectional area was (545.6±79.72)%, and the excellent and good rate was 93.5% based on modified MacNab criteria. Three patients developed numbness in the innervation area of nerve roots after operation, and all symptoms subsided within 3 months. No severe complications such as dural tear or nerve root injury occurred, and no recurrent cases were observed during the follow-up period.

Endo-ULBDD can achieve complete 360° spinal canal decompression and discectomy for patients with lumbar spinal stenosis combined with central lumbar disc herniation, with definite early clinical efficacy and high safety.