单侧双通道内镜下单纯减压与腰椎椎间融合术治疗Ⅰ度退变性腰椎滑脱的疗效比较研究  

Comparison of effectiveness between unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion for degreeⅠdegenerative lumbar spondylolisthesis

作　　者：付豪 胡宇童 杨东方 王鑫[2] 许卫兵 FU Hao;HU Yutong;YANG Dongfang;WANG Xin;XU Weibing(Graduate School of Dalian Medical University,Dalian Liaoning,116044,P.R.China;Department of Orthopedics,Dalian Central Hospital,Dalian Liaoning,116033,P.R.China;Department of Orthopedics,Osteoporosis Clinical Center,the Second Affiliated Hospital of Soochow University,Suzhou Jiangsu,215006,P.R.China;Graduate School of Soochow University,Suzhou Jiangsu,215006,P.R.China;Department of Orthopedics,Changzheng Hospital,Naval Medical University,Shanghai,200003,P.R.China)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]大连市中心医院骨科,辽宁大连116033 [3]苏州大学附属第二医院骨科/骨质疏松中心,江苏苏州215006 [4]苏州大学研究生院,江苏苏州215006 [5]海军军医大学附属长征医院骨科,上海200003

出　　处：《中国修复重建外科杂志》2024年第2期169-175,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较单侧双通道内镜(unilateral biportal endoscopy,UBE)下单纯减压与腰椎椎间融合术(unilateral biportal endoscopic lumbar interbody fusion,ULIF)治疗Ⅰ度退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的疗效。方法回顾性分析2021年10月—2022年10月收治并符合选择标准的58例Ⅰ度DLS患者临床资料,其中采用UBE下单纯减压治疗28例(减压组)、ULIF治疗30例(ULIF组)。两组患者性别、年龄、手术节段以及术前腰痛疼痛视觉模拟评分(VAS)、腿痛VAS评分、Oswestry功能障碍指数(ODI)、C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、椎间盘高度(disk height,DH)、节段前凸(segmental lordosis,SL)等基线资料比较,差异均无统计学意义(P>0.05)。比较两组手术时间、术后引流量、术后离床活动时间,术后腰痛VAS评分、腿痛VAS评分、ODI、实验室检查指标(CRP、ESR)、影像学参数(DH、SL)。结果与ULIF组相比,减压组手术时间短、术后引流量少且患者开始离床活动更早,差异均有统计学意义(P<0.05)。两组切口均Ⅰ期愈合,无神经根损伤、硬膜外血肿、感染等并发症发生。两组患者术后均获随访12个月。实验室检查示,减压组术后3 d ESR、CRP与术前差异均无统计学意义(P>0.05),而ULIF组术后3 d上述指标均较术前升高(P<0.05);两组间ESR、CRP手术前后差值比较,差异有统计学意义(P<0.05)。除减压组术后3 d腰痛VAS评分与术前差异无统计学意义(P>0.05)外,两组腰、腿痛VAS评分其他时间点间比较,差异均有统计学意义(P<0.05)。术后3 d ULIF组腰痛VAS评分高于减压组(P<0.05),其余时间点两组腰、腿痛VAS评分差异均无统计学意义(P>0.05)。两组术后ODI均较术前改善(P<0.05),但术后3 d与6个月间差异无统计学意义(P>0.05);术后两时间点组间差异均无统计学意义(P<0.05)。影像学检查示,减压组术后12个月DH、SL与术前差异无统计学�Objective To compare the effectiveness of unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion(ULIF)in the treatment of degree I degenerative lumbar spondylolisthesis(DLS).Methods A clinical data of 58 patients with degree I DLS who met the selection criteria between October 2021 and October 2022 was retrospectively analyzed.Among them,28 cases were treated with unilateral biportal endoscopic decompression(decompression group)and 30 cases with ULIF(ULIF group).There was no significant difference between the two groups(P>0.05)in the gender,age,lesion segment,and preoperative visual analogue scale(VAS)score of low back pain,VAS score of leg pain,Oswestry disability index(ODI),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),disk height(DH),segmental lordosis(SL),and other baseline data.The operation time,postoperative drainage volume,postoperative ambulation time,VAS score of low back pain,VAS score of leg pain,ODI,laboratory examination indexes(CRP,ESR),and imaging parameters(DH,SL)were compared between the two groups.Results Compared with the ULIF group,the decompression group had shorter operation time,less postoperative drainage,and earlier ambulation(P<0.05).All incisions healed by first intention,and no complication such as nerve root injury,epidural hematoma,or infection occurred.All patients were followed up 12 months.Laboratory tests showed that ESR and CRP at 3 days after operation in decompression group were not significantly different from those before operation(P>0.05),while the above indexes in ULIF group significantly increased at 3 days after operation compared to preoperative values(P<0.05).There were significant differences in the changes of ESR and CRP before and after operation between the two groups(P<0.05).Except that the VAS score of low back pain at 3 days after operation was not significantly different from that before operation in decompression group(P>0.05),there were significant differences in VAS score of low back pain and VA

关 键 词：退变性腰椎滑脱 单侧双通道内镜 减压 椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]