单侧双通道内镜下腰椎融合术与微创经椎间孔腰椎融合术治疗单节段腰椎管狭窄伴不稳症的早期临床疗效  

Clinical Effect of Unilateral Biportal Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion on Single-segment Lumbar Stenosis with Instability

作　　者：江潮[1] 黄永辉[1] 左华[1] 孙焱[1] 孙继芾[1] JIANG Chao;HUANG Yonghui;ZUO Hua;SUN Yan;SUN Jifu(Department of Orthopedics,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院骨科,江苏镇江212001

出　　处：《中国医学科学院学报》2022年第4期563-569,共7页Acta Academiae Medicinae Sinicae

基　　金：国家重点研发计划(2019YFC0121400);2019年度镇江市重点研发计划(社会发展)项目(SH2019031)。

摘　　要：目的 比较单侧双通道内镜下腰椎融合术(ULIF)与微创经椎间孔腰椎融合术(MIS-TLIF)治疗单节段腰椎管狭窄伴不稳症的早期临床疗效。方法 回顾性分析2020年8月至2021年5月本院行单节段腰椎管狭窄伴不稳症的手术患者,按照手术方法分为ULIF组和MIS-TLIF组。比较两组患者手术时间、手术后住院时间、围手术期出血量(术后48 h引流量、总失血量)、肌酸激酶、炎症因子(C反应蛋白、白细胞介素-6)、D-二聚体及下肢静脉血栓发生率。采用视觉模拟评分量表和Oswestry功能障碍指数对两组患者术前、术后1周、术后1个月和术后3个月的功能恢复效果进行评价。结果 ULIF组手术时间长于MIS-TLIF组(P<0.001),但手术后住院时间低于MIS-TLIF组(P=0.022)。ULIF组术后48 h引流量、总失血量均低于MIS-TLIF组(P均<0.001)。ULIF组术后第1、3天肌酸激酶(P均<0.001)、C反应蛋白(P<0.001,P=0.002)、白细胞介素-6(P=0.003,P<0.001)均低于MIS-TLIF组。ULIF组术后第1、3天D-二聚体与MIS-TLIF组相比,差异均无统计学意义(P=0.117,P=0.683);ULIF组与MIS-TLIF组术后均未出现下肢静脉血栓。ULIF组术后1周、术后1个月和术后3个月的视觉模拟评分量表与MIS-TLIF组相比差异均无统计学意义(P=0.447,P=0.578,P=0.538);ULIF组术后1周、术后1个月和术后3个月的Oswestry功能障碍指数评分与MIS-TLIF组相比差异均无统计学意义(P=0.832,P=0.797,P=0.619)。结论 ULIF术式治疗单节段腰椎管狭窄伴不稳症与MIS-TLIF术式疗效相似,且具有出血少、炎症反应轻、肌肉损伤小的优势,但手术时间相对延长。Objective To compare the early clinical effects of unilateral biportal endoscopic lumbar interbody fusion(ULIF) and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on single-segment lumbar stenosis with instability.Methods The patients who had single-segment lumbar spinal stenosis with instability and were treated in our hospital from August 2020 to May 2021 were selected.According to the operation methods, they were classified into ULIF group and MIS-TLIF group.The operation duration, hospital stay after operation, perioperative blood loss(drainage volume 48 h after operation, total blood loss),creatine kinase, inflammatory cytokines(C-reactive protein, interleukin-6),D-dimer, and the incidence of lower-extremity venous thrombosis were compared between the two groups.The visual analogue scale and Oswestry disability index were used to evaluate the functional recovery of the two groups in 1 week, 1 month, and 3 months after operation.Results The ULIF group had longer operation duration(P<0.001) and shorter hospital stay after operation(P=0.022)than the MIS-TLIF group.The drainage volume 48 h after operation and total blood loss in ULIF group were lower than those in MIS-TLIF group(all P<0.001).The levels of creatine kinase(all P<0.001),C-reactive protein(P<0.001,P=0.002),and interleukin-6(P=0.003,P<0.001) in ULIF group were lower than those in MIS-TLIF group on the 1 st and 3 rd day after operation.However, the D-dimer in ULIF group was insignificantly different from that in MIS-TLIF group on the 1 st and 3 rd day after operation(P=0.117,P=0.683).Lower-extremity venous thrombosis occurred in neither group.The score of visual analogue scale showed no significant difference between the two groups 1 week, 1 month, and 3 months after operation(P=0.447,P=0.578,P=0.538),so did the Oswestry disability index(P=0.832,P=0.797,P=0.619).Conclusion ULIF shows similar clinical effect on single-segment lumbar stenosis with instability to MIS-TLIF,which features less bleeding, mild inflammation, mild muscle in

关 键 词：单侧双通道内镜下腰椎融合术 微创经椎间孔腰椎融合术 腰椎管狭窄伴不稳症 

分 类 号：R681.5[医药卫生—骨科学]