椎间孔镜下腰椎椎间植骨融合术和微创经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的疗效比较  

Comparison of clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases

作　　者：李勇奇 罗瑞 汪少波 金勇 王健[1] 吴宏梓 王顺 袁峰 赵建新 白宗彪 廖燚 LI Yongqi;LUO Rui;WANG Shaobo;JIN Yong;WANG Jian;WU Hongzi;WANG Shun;YUAN Feng;ZHAO Jianxin;BAI Zongbiao;LIAO Yi(Department of Orthopaedics,Karamay Hospital of People’s Hospital of Xinjiang Uygur Autonomous Region(Karamay Central Hospital),Karamay 834000,China;Department of Neurology,Karamay Hospital of People’s Hospital of Xinjiang Uygur Autonomous Region(Karamay Central Hospital),Karamay 834000,China)

机构地区：[1]新疆维吾尔自治区人民医院克拉玛依医院(克拉玛依市中心医院)骨科,新疆维吾尔自治区克拉玛依市834000 [2]新疆维吾尔自治区人民医院克拉玛依医院(克拉玛依市中心医院)神经内科,新疆维吾尔自治区克拉玛依市834000

出　　处：《实用老年医学》2024年第3期273-277,共5页Practical Geriatrics

基　　金：新疆维吾尔自治区人民医院克拉玛依医院(克拉玛依市中心医院)院内项目(YK2019-2)。

摘　　要：目的比较椎间孔镜下腰椎椎间植骨融合术(Endo-LIF)和微创经椎间孔腰椎椎间融合术(MIS-TLIF)治疗腰椎退行性疾病的临床疗效及安全性。方法纳入2018年7月至2019年12月间克拉玛依市中心医院收治的符合标准的腰椎退行性疾病病人60例,根据手术方式分为Endo-LIF组30例和MIS-TLIF组30例。收集病人围手术期指标,包括手术时间、出血量、住院时间、并发症发生率及椎体间融合率,并于术前、术后1周、术后3、12个月采用VAS评分、日本骨科协会(JOA)评分和Oswestry功能障碍指数(ODI)评价病人的临床功能恢复情况。结果2组病人年龄、性别、临床诊断、融合节段、随访时间等基线特征差异均无统计学意义(P>0.05)。Endo-LIF组病人切口长度、术中出血量及平均住院时间均少于MIS-TLIF组,差异有统计学意义(P<0.05)。术后1周,术后3、12个月,2组病人VAS评分(腰背部、腿部)、ODI及JOA评分均较术前明显改善(P<0.05)。术后1周及术后3个月,Endo-LIF组腰背部VAS评分明显低于MIS-TLIF组;术后3个月,Endo-LIF组腿部VAS评分、ODI和JOA评分较MIS-TLIF组更低(P<0.05)。2组病人椎体融合率、并发症发生率差异均无统计学意义(P>0.05)。结论Endo-LIF技术治疗腰椎退行性疾病临床疗效良好,且安全微创,值得临床推广应用。Objective To compare the clinical efficacy,safety of percutaneous endoscopic transforaminal lumbar interbody fusion(Endo-LIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar degenerative diseases.Methods A total of 60 patients with lumbar degenerative diseases in Karamay Central Hospital from July 2018 to December 2019 were enrolled and divided into Endo-LIF group(30 cases)and MIS-TLIF group(30 cases)according to the surgery methods.Perioperative parameters,including operation time,estimated blood loss,length of hospital stay,perioperative complications and postoperative fusion rates were recorded,respectively.The Visual Analog Scale(VAS)score for back and leg,the Oswestry Disability Index(ODI)and the Japanese Orthopaedic Association(JOA)score were obtained preoperatively and 1 week,3 months and 12 months after surgery,respectively.Results There were no significant differences in age,gender,clinical diagnosis,fusion segment and follow-up time between the two groups(P>0.05).The incision length,intraoperative blood loss and average hospital stay in Endo-LIF group were significantly lower than those in MIS-TLIF group.The VAS scores(lower back pain and leg pain),ODI and JOA scores in the two groups were significantly improved 1 week,3 months and 12 months after surgery(P<0.05).The VAS score for back pain in Endo-LIF group was significantly lower than that in MIS-TLIF group 1 week and 3 months after surgery(P<0.05).The VAS score,ODI score and JOA score in Endo-LIF group were improved more significantly than those in MIS-TLIF group 3 months after surgery(P<0.05).There were no significant differences in terms of the interbody fusion rate and adverse reaction rate between the two groups(P>0.05).Conclusions Endo-LIF not only has a good clinical effect in the treatment of lumbar degenerative diseases,but also is a safe,minimally invasive technology,which is worthy of clinical application.

关 键 词：椎间孔镜下腰椎椎间植骨融合术 微创经椎间孔腰椎椎间融合术 腰椎退行性疾病 

分 类 号：R681.5[医药卫生—骨科学]