MED内镜辅助下与微创通道辅助下融合治疗腰椎滑脱症的近中期效果比较  

Comparison of Short and Medium Term Efficacy of MED Endoscope-assisted and Minimally Invasive Channel Assisted Fusion for Lumbar Spondylolisthesis

作　　者：向刚刚 曹鹏 高启龙 吴若冰 杨光[1] 夏鸿 张晓燕[1] 杨景帆[1] 陈建琨[1] 付义[1] XIANG Ganggang;CAO Peng;GAO Qilong;WU Ruobing;YANG Guang;XIA Hong;ZHANG Xiaoyan;YANG Jingfan;CHEN Jiankun;FU Yi(Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming 650011,China;不详)

机构地区：[1]昆明市中医医院,云南昆明650011

出　　处：《中国医学创新》2023年第12期56-61,共6页Medical Innovation of China

基　　金：云南省中医(骨伤)临床医学中心建设项目(20210701)。

摘　　要：目的:比较显微内镜椎间盘切除系统(microendoscopic discectomy,MED)辅助下微创经椎间孔腰椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与微创通道下TLIF(minimally invasive tubular TLIF,MT-TLIF)治疗腰椎管狭窄合并腰椎滑脱的近中期效果。方法:回顾性分析昆明市中医医院2017年6月-2021年3月收治的腰椎滑脱症患者共187例,按照手术方式分为MED组(98例)和通道组(89例),收集患者临床资料,并比较两组患者年龄、病程、性别、手术时间、手术节段,术中失血量、术后引流量、住院时间、切口愈合情况、切口总长度、腰部视觉模拟评分法(VAS)评分、腿部VAS评分、Cobb角和腰椎前凸角(lumbar lordosis,LL)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎弓钉置入的准确性评价、椎间融合评价等项目。结果:两组患者年龄、性别、病程、手术节段等术前资料比较,差异均无统计学意义(P>0.05)。在围手术期MED组比通道组手术时间更短、切口总长度更短、术中失血量更少(P<0.05)。两组患者术后各时间节点腰部VAS评分、腿部VAS评分、ODI评分比较,差异均无统计学意义(P>0.05)。两组患者术后Cobb角和腰椎前凸角(lumbar lordosis,LL)均明显改善(P<0.05),两组患者术后各时间节点比较,差异均无统计学意义(P>0.05);两组患者椎弓钉置入的准确性评价比较,差异无统计学意义(P>0.05);两组术后椎间融合评价各时间节点比较,差异均无统计学意义(P>0.05)。结论:MIS-TLIF与MT-TLIF在术后近中期疗效相当,但MIS-TLIF在手术时间、切口总长度、术中失血量等均明显优于MT-TLIF,治疗腰椎滑脱术式选择时,MIS-TLIF值得临床优先推荐。Objective:To compare the short and medium term efficacy of microendoscopic discectomy(MED)assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)with minimally invasive tubular TLIF(MT-TLIF)in the treatment of lumbar spinal stenosis with lumbar spondylolisthesis.Method:A total of 187 patients with lumbar spondylolisthesis admitted to Kunming Municipal Hospital of Traditional Chinese Medicine from June 2017 to March 2021 were retrospectively analyzed.According to the surgical method,they were divided into MED group(98 cases)and channel group(89 cases).Clinical data of patients were collected,and age,course of disease,gender,operation time,operation stage intraoperative blood loss,postoperative drainage volume,length of hospital stay,incision healing,total incision length,lumbar visual analog scale(VAS)score,leg VAS score,Cobb angle and lumbar lordosis angle(LL),Oswestry disability index(ODI),accuracy evaluation of vertebral screw placement,and evaluation of interbody fusion were compared between the two groups.Result:There were no significant differences in age,gender,disease duration,surgical segment,and other preoperative data between the two groups(P>0.05).In the perioperative period,the MED group had shorter operation time,shorter total incision length,and less intraoperative blood loss than the channel group(P<0.05).There were no significant differences in waist VAS score,leg VAS score and ODI score between the two groups at each time point after operation(P>0.05).The Cobb angle and LL of the two groups significantly improved after operation(P<0.05),but there were no significant differences between the two groups at each time point after operation(P>0.05).There was no significant difference in the accuracy of pedicle screw placement between the two groups(P>0.05).There were no significant differences in intervertebral fusion evaluation between two groups at each time point after operation(P>0.05).Conclusion:The efficacy of MIS-TLIF and MT-TLIF are similar in the near and middle postoperat

关 键 词：腰椎滑脱症 显微内镜椎间盘切除系统 微创经椎间孔腰椎体间融合术 微创通道下经椎间孔腰椎体间融合术 

分 类 号：R687.3[医药卫生—骨科学]