经皮内镜与微创经椎间孔腰椎间融合术治疗单节段退行性腰椎管狭窄的疗效对比  

Comparison of Efficacy of Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Spinal Stenosis

作　　者：刘兵兵 任志楠 张盼可 镐英杰[1] Liu Bingbing;Ren Zhinan;Zhang Panke(Department of Orthopedics,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中国微创外科杂志》2022年第7期553-558,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省医学科技攻关计划项目(LHGJ20190292)。

摘　　要：目的对比经皮内镜经椎间孔腰椎间融合术(percutaneous endoscopic transforaminal lumbar interbody fusion,PE-TLIF)和微创经椎间孔腰椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗退行性腰椎管狭窄症的疗效。方法回顾性分析2019年1月~2020年6月因单节段退行性腰椎管狭窄症行微创腰椎减压融合手术47例资料,依患者意愿选择手术方式,PE-TLIF组21例,MIS-TLIF组26例。比较2组手术指标,术后3天、3个月、6个月、12个月腰腿痛视觉模拟评分(Visual Analogue Scale,VAS),术后3、6、12个月Oswestry功能障碍指数(Oswestry Disability Index,ODI),术后12个月椎间融合情况,末次随访改良MacNab标准评价疗效。结果PE-TLIF组术中出血量、术后引流量较MIS-TLIF组明显减少[(91.8±13.6)ml vs.(115.2±16.1)ml,t=-5.311,P=0.000;(49.6±11.5)ml vs.(99.6±30.5)ml,t=-7.698,P=0.000],但手术时间长[(150.9±12.4)min vs.(101.0±9.9)min,t=15.321,P=0.000]。2组术后腰腿痛VAS评分及ODI较术前均明显下降(P=0.000),2组间差异无统计学意义(P>0.05)。术后12个月2组均达到骨性融合。2组术后并发症和优良率差异均无统计学意义(P>0.05)。结论微创手术PE-TLIF和MIS-TLIF治疗单节段退行性腰椎管狭窄症的疗效相当,同样安全、有效,PE-TLIF具有术中视野清晰、术中出血量少、术后早期腰痛程度轻的特点。Objective To compare the clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of patients with degenerative lumbar spinal stenosis.Methods Clinical data of 47 patients with single-segment degenerative lumbar spinal stenosis diseases who underwent lumbar decompression fusion surgery from January 2019 to June 2020 were retrospectively analyzed.According to the patients’wishes,they were divided into the PE-TLIF group(21 cases)and the MIS-TLIF group(26 cases).The outcomes of the two groups were compared,including surgical indexes,Visual Analogue Scale(VAS)of lumbar and leg pain at 3 days,3,6,and 12 months after surgery,Oswestry Disability Index(ODI)at 3,6,and 12 months after surgery,intervertebral fusion at 12 months after surgery,and the efficacy of modified MacNab criteria at the last follow-up.Results Compared with the MIS-TLIF group,the PE-TLIF group had less blood loss[(91.8±13.6)ml vs.(115.2±16.1)ml,t=-5.311,P=0.000]and drainage volume[(49.6±11.5)ml vs.(99.6±30.5)ml,t=-7.698,P=0.000],but longer operation time[(150.9±12.4)min vs.(101.0±9.9)min,t=15.321,P=0.000].The VAS score of lumbar and leg pain and ODI in both groups were significantly lower after surgery than preoperation(all P=0.000),and there were no significant differences between the two groups(P>0.05).Bone fusion was achieved in both groups at 12 months after surgery.There were no significant differences in postoperative complications and excellent and good rates between the two groups(P>0.05).Conclusions The minimally invasive surgery of PE-TLIF and MIS-TLIF have comparable efficacy for single-segment degenerative lumbar spinal stenosis,which are also safe and effective.PE-TLIF has the characteristics of clear intraoperative vision,less intraoperative bleeding,and mild degree of early postoperative low back pain.

关 键 词：腰椎管狭窄症 经皮内镜 微创手术 经椎间孔腰椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]