单侧双通道内镜腰椎融合术治疗Ⅰ度腰椎滑脱的初步研究  

Preliminary Study of Unilateral Biportal Endoscopic Lumbar Interbody Fusion for the Treatment of GradeⅠLumbar Spondylolisthesis

作　　者：宋鑫 镐英杰[1] 任志楠 于磊[1] 朱广铎 周威威 Song Xin;Hao Yingjie;Ren Zhinan(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10期814-819,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省医学科技攻关计划省部共建项目(SB201903001)。

摘　　要：目的比较单侧双通道内镜腰椎融合术(unilateral biportal endoscopic lumbar interbody fusion,ULIF)和微创经椎间孔入路腰椎融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗Ⅰ度腰椎滑脱的疗效。方法回顾性分析2019年5月~2021年3月56例Ⅰ度腰椎滑脱资料,其中ULIF 28例,MIS-TLIF 28例,2组年龄、性别、滑脱节段及滑脱类型差异无统计学意义(P>0.05)。比较2组围术期指标、临床疗效以及影像学参数。结果与MIS-TLIF组相比,ULIF组术中出血少(P<0.001),术后腰痛VAS评分和ODI降低更多(P<0.05)。末次随访2组椎间融合率和改良MacNab标准优良率差异无统计学意义(P>0.05)。2组滑脱率和L_(1)椎体轴到S_(1)椎体的距离术后显著下降(均P<0.001),腰椎前凸角和滑脱角术后显著升高(均P<0.001),2组间差异无统计学意义(P>0.05)。结论相较于MIS-TLIF,ULIF治疗Ⅰ度腰椎滑脱具有术中出血量少,手术切口小,术后腰痛恢复快等优势,可有效减少滑脱程度,改善腰椎矢状位平衡。Objective To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion(ULIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of gradeⅠlumbar spondylolisthesis.Methods A retrospective analysis was performed on 56 patients with gradeⅠlumbar spondylolisthesis admitted from May 2019 to March 2021,including 28 patients treated with ULIF and 28 patients with MIS-TLIF.There were no significant differences in age,gender,slippage segment and type of spondylolisthesis between the two groups(P>0.05).The perioperative indicators,clinical efficacy and imaging parameters were compared between the two groups.Results Compared with the MIS-TLIF group,the ULIF group had less intraoperative bleeding(P<0.001),and the VAS score of low back pain and ODI in the ULIF group after surgery were significantly lower than those in the MIS-TLIF group(P<0.05).At the final follow-up,there were no significant differences in the fusion rate and the excellent and good rate of modified MacNab criteria between the two groups(P>0.05).The slip percentage(SP)and L_(1) axis and S_(1) distance(LASD)in both groups were significantly decreased after surgery than those before surgery(P<0.001),and the lumbar lordosis(LL)and slip angle(SA)in both groups were significantly increased after surgery than those before surgery(P<0.001),without significant differences between the two groups(P>0.05).Conclusions Compared with MIS-TLIF,ULIF has advantages of less intraoperative blood loss,smaller surgical incision and faster recovery of low back pain at early period after operation.It can effectively reduce the degree of spondylolisthesis and improve the sagittal balance of lumbar spine.

关 键 词：腰椎滑脱 内镜 腰椎融合术 

分 类 号：R687.3[医药卫生—骨科学]