经皮内镜与开放腰椎后路椎间融合术治疗腰椎滑脱症的比较  

Clinical Comparison of Percutaneous Endoscopic and Open Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis

作　　者：武浩然 冯皓宇[1] 何李明 关晓明[1] 常强[1] Wu Haoran;Feng Haoyu;He Liming(Department of Orthopedics,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Taiyuan 030032,China)

机构地区：[1]山西医科大学第三医院山西白求恩医院骨科,太原030032

出　　处：《中国微创外科杂志》2023年第11期801-806,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：山西省医学科技创新团队建设计划(2020TD13)。

摘　　要：目的探讨经皮内镜腰椎后路椎间融合术(percutaneous endoscopic posterior lumbar interbody fusion,PE-PLIF)治疗腰椎滑脱症的效果。方法回顾性分析2019年1月~2020年10月单节段MeyerdingⅠ度或Ⅱ度腰椎滑脱症142例资料,其中PE-PLIF(内镜组)72例,开放PLIF(开放组)70例。2组一般资料无统计学差异(P>0.05),随访2年以上。比较2组围手术期指标、疗效评价指标和影像学数据。结果与开放组相比,内镜组术中出血少[(88.6±30.8)ml vs.(543.8±287.6)ml,t=-13.352,P=0.000]。2组术后各时点腰痛及腿痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)较术前均明显改善(P<0.05),内镜组术后1年、2年腰痛VAS评分低于开放组(P<0.05),术后1周内、1个月ODI低于开放组(P<0.05),其余各时点组间差异无统计学意义(P>0.05)。术后椎间隙高度、骨盆倾斜角等影像学指标均明显改善(P<0.05),组间差异无统计学意义(P>0.05)。2组融合率[93.1%(67/72)vs.94.3%(66/70),χ^(2)=0.000,P=1.000]和融合器沉降率[19.4%(14/72)vs.21.4%(15/70),χ^(2)=0.086,P=0.769]差异无统计学意义。结论对于Ⅰ、Ⅱ度腰椎滑脱症,相比于开放PLIF,经皮内镜PLIF可以减少术中出血,减轻腰背痛程度,加快术后康复。Objective To investigate the effect of percutaneous endoscopic posterior lumbar interbody fusion(PE-PLIF)in the treatment of lumbar spondylolisthesis.Methods Clinical data of 142 cases of single level Meyerding gradeⅠorⅡlumbar spondylolisthesis from January 2019 to October 2020 were retrospectively analyzed,including 72 cases in the endoscopic group and 70 cases in the open group.There was no significant difference in the general data between the two groups(P>0.05),and the follow-ups lasted for more than 2 years.The perioperative parameters,efficacy evaluation results,and imaging data of the two groups were compared.Results As compared to the open group,the endoscopic group had less intraoperative bleeding[(88.6±30.8)ml vs.(543.8±287.6)ml,t=-13.352,P=0.000].The Visual Analogue Scale(VAS)of back pain and leg pain and Oswestry Disability Index(ODI)in both groups were significantly improved at all time points after surgery as compared to preoperation(P<0.05).The VAS scores of back pain of the endoscopic group at 1 year and 2 years after surgery were lower than those of the open group(P<0.05),the ODI at 1 week and 1 month after surgery were lower than those of the open group(P<0.05),and there were no statistical significances at other time points between the two groups(P>0.05).Postoperative disc height,pelvic tilt,and other imaging indicators were significantly improved(P<0.05),and there were no statistical significances between the two groups(P>0.05).There were no significant differences between the two groups in the fusion rate[93.1%(67/72)vs.94.3%(66/70),χ2=0.000,P=1.000]and the cage subsidence rate[19.4%(14/72)vs.21.4%(15/70),χ2=0.086,P=0.769].Conclusion As compared to open PLIF,PE-PLIF can reduce intraoperative bleeding,reduce the degree of low back pain,and accelerate postoperative rehabilitation for gradeⅠandⅡlumbar spondylolisthesis.

关 键 词：内镜 腰椎 椎间融合术 腰椎滑脱症 

分 类 号：R687.3[医药卫生—骨科学]