Objective:To investigate the risk factors for recurrence after modified Chevron osteotomy for hallux valgus.Methods:A total of 86 patients (102 feet) with hallux valgus who underwent modified Chevron operation in Beijing Jishuitan Hospital from December 2018 to February 2021 were retrospectively analyzed. There were 12 males (14 feet) and 74 females (88 feet), aged 50±15 years (range, 18-74 years). There were 36 cases on the right side, 34 on the left side, and 16 on the bilateral side. 4 feet were treated with Chevron osteotomy, 74 feet with modified McBride's osteotomy, 61 feet with Weil osteotomy, 24 feet with Akin osteotomy, and 23 feet with gastrocnemius aponeurotic release. At the last follow-up, hallux valgus angle (HVA) ≤15° was defined as the non-recurrence group after hallux valgus operation, and HVA>15° was defined as the recurrence group after hallux valgus operation. Compare the age, gender, preoperative HVA, the first and second intermetatarsal angles (IMA) before and after operation, the metatarsus adductus angles (MAA) before and after operation, the Meary angles before and after operation, the distal metatarsal articular angles (DMAA) before and after operation, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores before and after operation, and the rotation of the first metatarsal head between the two groups of patients. Include the indicators with statistically significant differences in the binary variable logistic regression analysis to screen for the risk factors of recurrence after modified Chevron operation for hallux valgus.Results:All patients successfully completed the operation and were followed up for 30.3±16.4 months (range, 12-52 months). Postoperative recurrence occurred in 21 feet, and the recurrence rate was 20.6% (21/102). The HVA at the last follow-up was 8.48°±4.52° in the non-recurrence group and 20.68°±3.61° in the recurrence group. In the non-recurrence group, the AOFAS ankle-hindfoot score increased from 60.31±16.62 points preoperatively to 86.89±12.79 points postoperatively ( t=-13.644, P<0.001). In the recurrent group, the AOFAS ankle-hindfoot score increased from 61.71±15.68 points preoperatively to 84.33±18.84 points postoperatively ( t=-6.082, P<0.001). The proportion of patients with preoperative Meary angle> 4° in the non-recurrence group was 52% (10/21), which was lower than 79% (64/81) in the recurrence group, and the difference was statistically significant (χ 2=6.077, P=0.014). The proportion of patients with square type of metatarsal rotation (type A) in the recurrence group was 58%(47/81), which was higher than 33%(7/21) in the non-recurrence group, and the difference was statistically significant (χ 2=4.081, P=0.043). There was no significant difference in gender, age, preoperative HVA, pre- and post-operative IMA, pre- and post-operative DMAA, pre- and post-operative MAA, or preoperative metatarsal rotation type between the two groups ( P>0.05). The results of the logistic regression analysis showed that a preoperative Meary angle ≤ 4° ( OR=3.299, P=0.024) and a non-type A metatarsal rotation pattern after operation ( OR=4.183, P=0.041) were independent risk factors for recurrence after modified Chevron operation for hallux valgus. Conclusion:Hallux valgus patients with a preoperative Meary angle ≤4° and non-type A metatarsal rotation after operation have an increased risk of recurrence following modified Chevron operation.

A rare case of Langerhans cell histiocytosis (LCH) combined with Erdheim-Chester disease (ECD) in the tibia is presented. A 55-year-old female patient experienced a six-month history of left lower leg pain of unknown origin, which progressively worsened over the past month and was accompanied by restricted mobility. Radiographic imaging revealed patchy, mixed-density shadows within the medullary cavities of the middle and lower segments of both tibiae and fibulae. Magnetic resonance imaging (MRI) showed extensive abnormal signal areas in the lower segments of the left tibia and fibula, as well as in the left talus and calcaneus. Positron emission tomography-computed tomography (PET-CT) demonstrated significantly increased diffuse radioactive uptake in the middle and lower segments of both femora, the upper and lower segments of the tibiae, the bilateral talus, the distal radius, and symmetrical uptake in the bilateral elbow joints. Additionally, mild radionuclide uptake was observed in the bilateral clavicles and the upper segment of the right femur. The initial diagnosis suggested a space-occupying lesion in the tibia with a suspicion of ECD. Histopathological examination of a biopsy from the left tibial lesion indicated a histiocytic proliferative disorder. After a multidisciplinary consultation, a definitive diagnosis of LCH with fibrous hyperplasia and extensive infiltration of foam cells, along with scattered multinucleated giant cells, was established. The presence of the BRAFV600E mutation further supported the concurrent diagnosis of ECD. Subcutaneous interferon-α therapy was initiated. Two years later, pulmonary lesions were identified. Computed tomography (CT) revealed multiple round nodules in both lungs, chronic inflammatory changes, and fibrous cord-like lesions. Consequently, interferon treatment was discontinued, and oral vemurafenib was administered. After three years of follow-up, chest CT demonstrated a significant reduction in chronic inflammatory lesions and fibrous cords, along with a decrease in nodule size. Currently, after four years of continuous follow-up, the patient remains in stable condition, experiences no significant discomfort, and continues to receive vemurafenib maintenance therapy. A review of the literature suggests that the co-occurrence of LCH and ECD is rare, often leading to misdiagnosis or delayed diagnosis. While no standardized treatment protocol exists, patients harboring the BRAFV600E mutation may benefit from BRAF inhibitors such as vemurafenib.

Hallux valgus is one of the common foot deformities. Osteotomy can effectively correct hallux valgus and relieve pain. In recent years, minimally invasive osteotomy for hallux valgus has attracted the attention of doctors and patients due to its perioperative advantages (small incision and fast recovery) and effectiveness. Compared with the first and second generation minimally invasive osteotomy techniques for hallux valgus, the third generation of minimally invasive techniques has the advantages of easy osteotomy, strong correction ability, and stable internal fixation, so it has been rapidly promoted at home and abroad. Although it has been reported that the third generation of minimally invasive techniques has satisfactory therapeutic effects, complications such as nerve damage and metastatic metatarsalgia are reported as well. Therefore, there are many key points and skills in the surgery that deserve attention. A high-torque power system, portable intraoperative fluoroscopy equipment, and appropriate reduction and internal fixation instruments are all prerequisites for the technique. The minimally invasive osteotomy is V-shaped or transverse (some surgeons define the transverse osteotomy as the fourth-generation technique). The direction of osteotomy is recommended to be perpendicular to the second metatarsal. Three-dimensional orthopedics should be paid attention to when extrapolating metatarsal heads such as crowbars, "in-out-in" method can be used to avoid the dorsomedial cutaneous nerve when internal fixation and nail placement, the continuity of the contralateral cortex should be preserved as much as possible when Akin osteotomy is used, the release of the lateral adductor muscle and the tightening of the medial joint capsule are helpful to further achieve soft tissue balance, and good postoperative bandaging and analgesia are also important links to ensure the treatment effect. In summary, it requires a certain learning curve and operational experience to master the minimally invasive technique. Performing surgery according to indications, doing a good job of preoperative evaluation and perioperative management are conducive to obtaining a good prognosis.

Objective:To explore the clinical efficacy of the fourth-generation minimally invasive surgery (MIS) for the treatment of hallux valgus.Methods:A retrospective analysis was conducted on 26 patients (42 feet) who underwent fourth-generation MIS for hallux valgus at Peking University People's Hospital from October 2019 to March 2023. The patients included 5 males (9 feet) and 21 females (33 feet), with an average age of 49.9±15.1 years (range 19-75 years). The hallux valgus deformity was corrected through minimally invasive extra-articular transverse osteotomy of the distal metatarsal combined with Akin osteotomy, fixation with a single fully threaded screw, and lateral soft tissue release after osteotomy. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured before surgery and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the visual analogue scale (VAS) were used to evaluate the treatment efficacy.Results:All 26 patients (42 feet) were followed up for a mean duration of 9.6±5.2 months (range 6-30 months). All 42 feet successfully underwent surgery, with an average operation time of 69.1±16.2 minutes (range 30-105 minutes) and an average blood loss of 10.0±7.4 ml (range 1-30 ml). No serious complications such as major vessel, nerve, or tendon damage occurred during the surgery for any patient. During the follow-up, one foot developed stiffness in the first metatarsophalangeal joint due to a lack of timely functional exercise after surgery. No other complications such as recurrence, delayed union, or nonunion were observed. By the final follow-up, one patient (2 feet) requested removal of the internal fixation. The HVA before surgery and at the final follow-up was 29.5±7.4 and 9.2±4.6, respectively, while the IMA was 11.9±3.8 and 5.0±3.6. The AOFAS score improved from 56.6±10.2 to 91.7±6.8, and the VAS score decreased from 5.2±2.3 to 0.9±1.1, all with significant differences ( P<0.05). Conclusion:The fourth-generation minimally invasive surgery for hallux valgus, characterized by minimally invasive transverse osteotomy, fixation with a single fully threaded screw, lateral soft tissue release after osteotomy, and Akin osteotomy is simple, safe, effective and easy to operate with fewer complications.

Objective:To investigate the clinical efficacy of 3D-printed metal augment or integrated acetabular prostheses for reconstruction of bone defects in hip revision.Methods:A total of 11 patients who underwent total hip revision in Zhengzhou Orthopaedic Hospital from June 2021 to July 2023 were retrospectively analysed. There were 5 males and 6 females, age 64.8±10.7 years (range, 58-75 years), and body mass index 23.3±4.8 kg/m 2 (range, 21-27 kg/m 2). Paprosky classification of acetabular bone defects: 3 cases of type IIA, 4 cases of type IIB, 3 cases of type IIIA, 1 case of type IIIB. Reasons for revision: 8 cases of aseptic loosening, 3 cases after infection exclusion procedure. A 3D-printed metal augment was used in 9 cases (8 cases of aseptic loosening and 1 case of infected exclusion procedure) and a 3D-printed integrated acetabulum was used in 2 cases (infected exclusion procedure). The time from primary total hip arthroplasty to revision was 11.8±5.6 years (range, 5-17 years). Harris hip score and visual analogue scale (VAS) were used to evaluate the improvement of hip function and pain recovery. The leg length discrepancy, vertical height and horizontal position of the hip rotation center were measured on pelvic anteroposterior X-ray films. Results:All patients successfully completed the operation. The operation time was 145.9±35.5 min (range, 110-159 min), and the intraoperative blood loss was 950.5±310.8 ml (range, 680-1,450 ml). The postoperative Harris hip function score was significantly higher than that before operation ( F=554.085, P<0.001). One year after operation, the Harris hip function score was 74.36±5.16, which was higher than that before operation 32.18±4.07, and the difference was statistically significant ( P<0.05). The VAS scores of all patients decreased after operation, and the difference was statistically significant compared with that before operation ( F=177.717, P<0.001). The VAS score at 1 year after operation was 1.27±0.65, which was lower than that before operation 6.18±1.17, and the difference was statistically significant ( P<0.05). The preoperative leg length discrepancy was 1.97±0.71 cm, which was greater than 0.69±0.52 cm at the last follow-up, and the difference was statistically significant ( t=4.824, P<0.001). The vertical height of the hip rotation center was 1.88±0.46 cm on the affected side and 1.67±0.35 cm on the healthy side, showing no significant difference ( t=1.205, P=0.242). The postoperative horizontal position of the hip rotation center was 3.48±0.55 cm on the affected side and 3.54±0.32 cm on the healthy side, and the difference was no statistically significant ( t=-0.313, P=0.758). One case had an intraoperative greater trochanteric fracture that healed 3 months after reduction and internal fixation. All patients were followed up for 21.3±9.5 months (range, 15-31 months). All incisions healed in one stage, and all patients were fully weight-bearing at 3 months after operation. At the last follow-up, there was no case of loosening, dislocation or infection of the prosthesis; 4 cases had mild claudication, 1 case had heterotopic ossification, and the patients had good hip flexion and extension functions, which did not affect daily life without further treatment. Conclusion:The clinical efficacy of 3D-printed metal augment or integrated acetabular prosthesis for reconstruction of acetabular bone defects is satisfactory, which can restore the normal center of rotation of the hip joint and has a low incidence of postoperative complications.

Objective:To evaluate the short-term clinical outcomes of minimally invasive surgery for severe hallux valgus deformity using absorbable screw fixation.Methods:This retrospective study included 35 patients with severe hallux valgus deformities treated with third-generation minimally invasive Chevron and Akin osteotomies (MICA) using absorbable screws at the Foot and Ankle Surgery Department of Guangzhou Orthopedic Hospital from January 2022 to January 2023. The cohort consisted of 2 males and 33 females, with an average age of 56.75±13.27 years (ranging from 20 to 72 years).There were 18 cases of left foot and 17 of right. Preoperative and 12-month postoperative radiographic and clinical data were collected and analyzed. Radiographic evaluations included measurements of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) on weight-bearing foot X-ray films. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the visual analogue scale (VAS) for pain. All complications during follow-up were recorded to comprehensively assess surgical outcomes and safety.Results:All the 35 cases successfully underwent the surgery, with a surgery time of 61.5±3.2 minutes and intraoperative blood loss of 5.4±1.2 ml. No patients lost follow-up, with a mean follow-up of 15.65±2.48 months (ranging from12 to 19 months). At the final follow-up, the AOFAS score significantly improved from 39.8±4.7 preoperatively to 92.3±4.1 postoperatively ( P<0.05), and the VAS significantly decreased from 8.7±1.2 to 1.8±0.8 ( P<0.05). The HVA decreased from 42.5°±4.1° to 12.5°±3.7° ( P<0.05), and the IMA decreased from 18.5°±2.8° to 7.3°±2.1° ( P<0.05). Radiographic follow-up demonstrated complete osseous union at the osteotomy sites in all cases, with no complications of nonunion or displacement. 7 patients with concurrent gastrocnemius tightness underwent gastrocnemius release, and 11 patients with associated transfer metatarsalgia were treated with Weil osteotomy ( n=8) or metatarsal head recontouring ( n=3), achieving satisfactory outcomes for all cases. Complications were minimal, with 2 cases of localized numbness around the surgical incision observed on postoperative day 3; the symptoms were gone spontaneously 3 months postoperatively. No other major complications, such as infection, hematoma, or neurovascular injury, were observed. Conclusion:Minimally invasive surgery using absorbable screw fixation effectively improves clinical function and symptoms in patients with severe hallux valgus deformities without any major complications, suggesting that it is a safe and effective treatment option.

Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To compare the clinical efficacy of Chevron-Akin osteotomy with cannulated compression screw and absorbable screw fixation in the treatment of moderate and severe hallux valgus.Methods:The data of 52 patients with moderate to severe hallux valgus treated in Sichuan Provincial Orthopaedic Hospital from January 2020 to December 2022 were retrospectively analyzed. According to the fixation method, they were divided into metal screw group and absorbable screw group. In the metal screw group, there were 25 cases (26 feet), 2 males (2 feet) and 23 females (24 feet), aged 36.7±4.9 years (range, 21-59 years), 12 feet on the left side, 14 feet on the right side, moderate 20 feet and severe 6 feet. There were 27 cases (29 feet) in the absorbable screw group, including 1 male (1 foot) and 26 female (28 feet), aged 34.1±5.5 years (range, 19-56 years), 16 feet on the left side, 13 feet on the right side, moderate 22 feet and severe 7 feet. The healing time and complications of osteotomy were recorded between the two groups, and the hallux valgus angle (HVA), first-second intermetatarsal angle (1-2 IMA), American Orthopaedic Foot and Ankle Society (AOFAS), hallux-metatarsophalangeal-interphalangeal joint score and visual analogue scale (VAS) for pain were compared before and after the operation.Results:All 52 patients were followed up. The follow-up time was 14.0±3.4 months (range, 11-27 months) in the metal screw group and 15.1±2.7 months (range, 13-24 months) in the absorbable screw group. In all patients, the incision healed in one stage, and no endovegetal rejection occurred. The osteotomy healing time was 3.8±0.8 months (range, 2-5 months) in the metal screw group and 3.4±1.1 months (range, 2.5-5 months) in the absorbable screw group, with no statistically significant difference ( t=1.014, P=0.417). In the metal screw group, there were symptoms of medial internal fixation irritation in 2 feet, medial osteophyte or thread knot irritation in 2 feet, and hallux valgus recurrence in 1 foot. The complication rate was 19%(5/26). In the absorbable screw group, medial osteophyte or thread knot stimulated one foot and hallux valgus recurred one foot, and the complication rate was 7%(2/29). The difference in complications between the two groups was statistically significant (χ 2=8.051, P=0.012). At 12 months after operation, for the metal screw group and the absorbable screw group, HVA (13.7°±2.1° and 12.9°±3.8°), 1-2 IMA (7.2°±1.5° and 7.8°±1.2°), AOFAS score (91.4±2.2 and 90.8±3.6 points) and VAS score (1.1±0.3 and 1.3±0.4 points), respectively, were significantly higher than those in the preoperative (HVA: 37.2°± 5.4° and 35.8°±4.7°, 1-2 IMA: 18.3°± 1.8° and 17.9°±1.7°, AOFAS score: 60.4±5.6 and 58.4±7.1 points, VAS: 6.4±0.6 and 6.8±0.4 points) improvement ( P<0.05), while there was no statistically significant difference between the two groups ( P>0.05). The incidence of complications in metal screw group was 19%(5/26), while in absorbable screw group it was 7%(2/29), with a statistically significant difference (χ 2=8.051, P=0.012). Conclusions:Both cannulated compression screw in Chevron-Akin osteotomy and absorbable screw fixation can have a good fixation effect in the treatment of moderate and severe hallux valgus. Absorbable screw fixation has the advantages of low complication rate, less interference with artifacts in later imaging examination and evaluation.

Objective:To analyze the clinical value of delayed solidification of cement at freezing point combined with establishment of cement channels in the treatment of further leakage of cement in percutaneous kyphoplasty (PKP).Methods:A retrospective analysis was performed for the medical records of 261 patients with osteoporotic vertebral fracture in the thoracolumbar segment who underwent PKP treatment in Beijing Puren Hospital from April 2019 to April 2023. According to the method of dealing with PKP cement leakage, it was divided into freezing point group (using bone cement combined with cement channel reconstruction treatment at freezing point temperature) and temperature gradient group (using temperature gradient method). There were 128 cases in the freezing point group, including 37 males and 91 females, aged 75.57±4.60 years (range, 65-85 years), and fracture locations were 18 cases in T 10, 30 cases in T 11, 44 cases in T 12, 23 cases in L 1 and 13 cases in L 2. There were 133 cases in the temperature gradient group, including 36 males and 97 females, aged 75.66±4.51 years (range, 65-85 years), and fracture locations were 17 cases in T 10, 32 cases in T 11, 51 cases in T 12, 22 cases in L 1, and 11 cases in L 2. The intraoperative blood loss, operation time, intravertebral cement area, cement leakage area, cement leakage area increase, cement bolus time and incidence of injection difficulty, as well as the pain visual analogue scale (VAS), Oswestry disability index (ODI), kyphosis angle, the height of the anterior edge of the injured vertebral body and the difference between it before and after surgery were compared. Results:All patients were followed up for 3 consecutive months. The intraoperative blood loss and initial cement leakage area were 9.48±2.64 ml and 32.56±7.05 mm 2 in the freezing point group and 9.04±2.25 ml and 32.86±7.00 mm 2 in the temperature gradient group, respectively, and the difference was not statistically significant ( P>0.05) ; The operation time, the area of bone cement in the vertebral body, the final leakage area of bone cement, and the increase of bone cement leakage in the freezing point group were 55.08±4.13 min, 1 175.45±117.11 mm 2, 35.84±8.67 mm 2, and 0.00(0.00, 13.32) mm 2, respectively, and the temperature gradient group were 53.02±3.96 min, 823.70±144.79 mm 2, and 73.38±29.16 mm 2 and 44.39(20.13, 56.61) mm 2, the differences were statistically significant ( P<0.05). The height of the anterior edge of the vertebral body was 21.54±2.06 mm and 21.24±2.33 mm immediately after surgery and 3 months after surgery in the freezing point group, which were higher than those in the temperature gradient group 21.10±1.60 mm and 18.92±1.51 mm, respectively, and the difference was statistically significant ( P<0.05). The VAS scores of the freezing point group were 2.29±0.62 and 1.03±0.66 points, ODI were 23.20%±3.97%, 10.43%±4.33%, and the kyphosis angles were 9.09°±2.80° and 9.44°±2.93°, respectively, which were lower than those of the temperature gradient group (4.11±0.79 and 2.79±0.65 points), ODI (35.97%±6.42%, and 23.73%±5.72%), and the kyphosis angles (10.24°±2.33° and 13.22°±2.56°), the differences were statistically significant ( P<0.05). The operating time of bone cement in the freezing point group was 10.89±2.35 min, which was longer than that in the temperature gradient group 5.77±0.52 min, and the difference was statistically significant ( t=24.021, P<0.001). The incidence of cement injection difficulty was 0 in the freezing point group and 27.1% (36/133) in the temperature gradient group. Conclusion:The establishment of bone cement combined with bone cement channel at freezing point temperature can effectively prolong the bolus time of bone cement and reduce the re-leakage of bone cement, which is conducive to increasing the injection volume and distribution area of bone cement in the vertebral body, effectively reducing the amount of bone cement leakage and obtaining better clinical efficacy.

Objective:To observe the clinical efficacy of unilateral biportal endoscopy (UBE) assisted bilateral decompression in the treatment of lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side.Methods:A total of 20 patients with lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side treated with UBE from January 2022 to January 2024 in the Affiliated Hospital of Binzhou Medical University were retrospectively analyzed. There were 9 males and 11 females, aged 50.4±14.0 years (range, 23-72 years). The intervertebral disc herniation level included L 3-4 in 1 case, L 4-5 in 15 cases, and L 5S 1 in 4 cases. There were 10 cases on the left side and 10 cases on the right side. The duration of symptoms was 24.1±33.7 months (range, 1-120 months). Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate postoperative pain relief and functional recovery. The clinical efficacy was evaluated by modified MacNab criteria at 6 months after operation. Results:All patients successfully completed the operation. The operation time was 90.3±24.6 min (range, 55-134 mins). The VAS scores of patients at 3 days, 1 month, 3 months and 6 months after operation were 3.6±0.9, 2.2±0.7, 1.2±0.5 and 1.0±0.6, respectively, which were lower than those before operation (6.4±0.8), and the differences were statistically significant ( F=668.728, P<0.001). The ODI at 3 days, 1 month, 3 months and 6 months after operation were 34.2%±4.7%, 28.7%±2.8%, 24.3%±2.1% and 20.5%±2.0%, respectively, which were lower than 69.4%±5.2% before operation, and the differences were statistically significant ( F=515.578, P<0.001). The clinical efficacy was evaluated by modified MacNab criteria at 6 months after operation. Among 20 patients, 18 cases were excellent, 1 case was good, and 1 case was fair. All patients were followed up for 9.1±2.1 months (range, 6-14 months). One patient had a dural tear during the operation, but the range was small and there was no defect, and no further treatment was performed. Numbness of the lower limbs occurred 1 day after operation, and the symptoms disappeared after symptomatic treatment. There was no recurrence of lower limb symptoms, lumbar instability, intervertebral space infection or other complications at the last follow-up. Conclusion:Bilateral decompression with UBE is effective in the treatment of lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side, which can improve the lumbar pain and function of patients.