倾向性评分匹配两种腰椎融合方案治疗单节段腰椎退行性疾病  

Two lumbar fusion regimens in treatment of single-level lumbar degenerative diseases based on propensity score matching

作　　者：万健 王宁 贝朝涌[2] 陈远明 王洪岗 Wan Jian;Wang Ning;Bei Chaoyong;Chen Yuanming;Wang Honggang(Department of Spine Surgery,Affiliated Hospital of Guilin Medical College,Guilin 541000,Guangxi Zhuang Autonomous Region,China;Department of Trauma,Affiliated Hospital of Guilin Medical College,Guilin 541000,Guangxi Zhuang Autonomous Region,China;Department of Orthopedics,Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]桂林医学院附属医院脊柱外科,广西壮族自治区桂林市541000 [2]桂林医学院附属医院创伤外科,广西壮族自治区桂林市541000 [3]广西医科大学第二附属医院骨科,广西壮族自治区南宁市530007

出　　处：《中国组织工程研究》2024年第12期1914-1919,共6页Chinese Journal of Tissue Engineering Research

基　　金：“十三五”国家重点研发计划项目(2019YFC0121400-005),项目负责人:王洪岗;国家自然科学基金资助项目(81660366,82160416),项目负责人:贝朝涌;桂林医学院教育教学研究与改革项目(JG201937),项目负责人:贝朝涌。

摘　　要：背景:国内外近年来广泛使用单侧双通道内镜技术行椎间融合,但其与微创经椎间孔入路腰椎椎体间融合(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎退行性疾病的临床疗效对比仍较少,单侧双通道内镜技术是否是一种安全、高效的腰椎融合术式有待进一步论证。目的:对比单侧双通道内镜腰椎椎间融合(unilateral biportal endoscopic lumbar interbody fusion,UBE-LIF)与MIS-TLIF治疗腰椎退行性疾病的临床疗效,探讨更高效的腰椎融合术式。方法:纳入桂林医学院附属医院2020年10月至2022年2月收治的单节段腰椎退行性疾病患者,其中行UBE-LIF的患者35例,行MIS-TLIF的患者286例,采用倾向性评分匹配消除混杂因素,选取性别、年龄、疾病类型、手术节段4个协变量进行1∶1(卡钳值为0.01)匹配,匹配后两组各29例患者纳入研究。比较两组患者围术期中手术时间、血红蛋白丢失量、住院时间;采用目测类比和功能障碍指数对两组患者术前、术后1个月、术后半年、术后1年的功能恢复效果进行评价;末次随访采用改良MacNab标准评定两组疗效的优良率,采用Lenke腰椎骨性融合动态X射线片评估两组的植骨融合情况。结果与结论:①在手术时间上MIS-TLIF组短于UBE-LIF组(P<0.05),MIS-TLIF组术中血红蛋白丢失量高于UBE-LIF组、住院时间长于UBE-LIF组,差异有显著性意义(P<0.05);②两组患者术后1个月、术后半年、术后1年的腰痛目测类比评分、腿痛目测类比评分及Oswestry功能障碍指数相较于术前均有显著降低(P<0.05);除了术后1个月腰痛目测类比评分,在以上各时间节点随访两组腰痛、腿痛目测类比评分及Oswestry功能障碍指数无明显差异(P>0.05);③末次随访改良MacNab标准疗效评定结果显示,UBE-LIF组优良率为93%(27/29);MIS-TLIF组优良率为90%(26/29),两组差异无显著性意义(P>0.05);④Lenke腰椎骨性融合动态X射线片评�BACKGROUND:Unilateral biportal endoscopic technique has been widely used in lumbar interbody fusion in recent years,but there is little comparison between its clinical efficacy and that of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar degenerative disease,whether the unilateral biportal endoscopic technique is a safe and effective lumbar fusion remains to be further demonstrated.OBJECTIVE:To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF)and MIS-TLIF in the treatment of lumbar degenerative diseases and explore a more efficient lumbar fusion procedure.METHODS:Patients with single-level lumbar degenerative disease were enrolled in Affiliated Hospital of Guilin Medical College from October 2020 to February 2022,including 35 patients who underwent UBE-LIF and 286 patients who underwent MIS-TLIF.Propensity score matching was used to eliminate confounders.Four covariates including sex,age,disease type and surgical segment were matched 1:1(caliper value 0.01).After matching,29 patients from each group were included in the study.The perioperative operative time,hemoglobin loss and hospital stay were compared between the two groups.Visual analog scale score and Oswestry disability index were used to evaluate the functional recovery of the two groups before,1,6 months and 1 year after operation.The excellent and good rate of the two groups was evaluated by the modified MacNab standard at the last follow-up.The fusion of the two groups was evaluated by Lenke Dynamic X-ray film.RESULTS AND CONCLUSION:(1)The operative time in the MIS-TLIF group was shorter than that in the UBE-LIF group(P<0.05).The amount of intraoperative hemoglobin loss in the MIS-TLIF group was higher than that in the UBE-LIF group.The hospital stay in the MIS-TLIF group was longer than that in the UBE-LIF group,and the differences were statistically significant(P<0.05).(2)The visual analog scale scores for lumbago and leg pain,and Oswestry disability index wer

关 键 词：单侧入路双通道内镜 微创 经椎间孔入路 腰椎椎体间融合术 临床疗效 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681