脊柱内镜联合膨胀式椎间融合治疗腰椎不稳  

Endoscopic lumbar interbody fusion by expandable cage for degenerative lumbar instability

作　　者：郭旗[1] 张舜[1] 张传林[1] 黄久勤[1] GUO Qi;ZHANG Shun;ZHANG Chuan-lin;HUANG Jiu-qin(Department of Orhopedics,The First People's Hospital of Shangqiu Cily,Sangqiu 476100 China)

机构地区：[1]商丘市第一人民医院骨科,河南商丘476100

出　　处：《中国矫形外科杂志》2022年第13期1169-1173,共5页Orthopedic Journal of China

摘　　要：[目的]评价脊柱内镜下单纯应用膨胀式椎间笼架(expandable cage, EC)治疗退行性腰椎不稳的临床效果。[方法] 2018年3月—2019年12月,对108例退行性腰椎不稳患者行手术治疗。依据术前医患沟通结果,52例采用脊柱内镜下单纯EC融合,56例采用传统开放后路腰椎体间融合(posterior lumbar interbody fusion, PLIF)。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,无严重术后并发症。两组手术时间差异无统计学意义(P>0.05)。但EC组术中出血量、术后引流量及住院时间均显著优于PLIF组(P<0.05)。所有患者均获随访12个月以上。随时间推移,两组VAS和ODI评分显著下降(P<0.05),而JOA评分显著增加(P<0.05)。术后8周,EC组的VAS、ODI和JOA评分均显著优于PLIF组(P<0.05),但是末次随访时两组VAS、ODI和JOA评分的差异均无统计学意义(P>0.05)。影像方面,两组椎间融合时间差异无统计学意义(P>0.05)。与术前相比,末次随访时两组局部腰椎前凸角均显著增大,相应时间点两组间局部腰椎前凸角的差异均无统计学意义(P>0.05)。[结论]脊柱内镜下单纯EC治疗退行性腰椎不稳的短期临床效果优于PLIF术式,且手术创伤更小。[Objective] To evaluate the clinical outcomes of mere endoscopic lumbar interbody fusion by using expandable cage(EC)for degenerative lumbar spinal instability. [Methods] From March 2018 to December 2019, 108 patients with degenerative lumbar spine instability were surgically treated in our department. According to the consequence of preoperative doctor-patient communication, 52 patients underwent spinal endoscopic EC fusion, while 56 patients received traditional open posterior lumbar interbody fusion(PLIF). The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious postoperative complications. There was no statistical difference in operation time between the two groups(P>0.05), however, the EC group was significantly better than the PLIF group in terms of intraoperative blood loss, postoperative drainage and hospital stay(P<0.05). As time went during the follow-up period lasted for more than 12 months, the VAS and ODI scores decreased significantly(P<0.05), while the JOA score increased significantly in both groups(P<0.05). At 8 weeks postoperatively, the EC group were significantly superior to the PLIF group in terms of VAS, ODI and JOA scores(P<0.05), but which became not statistically significant between the two groups at the last follow-up(P>0.05). With respect of radiographic evaluation, there was no statistical difference in the time of intervertebral fusion between the two groups(P>0.05). The local lumbar lordosis angle increased significantly at the last follow-up in both groups compared with that preoperatively(P<0.05), however, there was no a significant difference in the local lumbar lordosis angle between the two groups at any corresponding time point(P>0.05). [Conclusion] The endoscopic lumbar interbody fusion by EC alone does achieve better short-term clinical outcome, with less surgical trauma than the traditional PLIF.

关 键 词：退行性腰椎不稳 腰椎间融合 膨胀式笼架 内镜 

分 类 号：R683.2[医药卫生—骨科学]