经皮内镜下可撑开融合器用于腰椎后路椎间融合的疗效及影像学分析  

Clinical efficacy and imaging analysis of percutaneous endoscopic posterior lumbar interbody fusion with a distraction cage

作　　者：李亚坤 何李明[1] 崔浩 武浩然 冯皓宇[1] Li Yakun;He Liming;Cui Hao;Wu Haoran;Feng Haoyu(Shanxi Academy of Medical Sciences,Department of Spinal Surgery,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Taiyuan 030032,China)

机构地区：[1]山西医学科学院,山西医科大学第三医院,山西白求恩医院脊柱外科,太原030032

出　　处：《骨科临床与研究杂志》2024年第3期151-157,共7页Journal Of Clinical Orthopedics And Research

基　　金：山西省医学科技创新团队基金(2020TD13)。

摘　　要：目的探讨经皮内镜腰椎后路椎间融合术(PE-PLIF)置入可撑开钛合金材质融合器进行椎间融合治疗腰椎退行性疾病的临床疗效。方法回顾性分析2019年5月至2021年7月于山西医科大学第三医院脊柱外科行PE-PLIF治疗72例腰椎退行性疾病患者的资料;其中术中置入可撑开钛合金材质融合器(可撑开组)39例、静态PEEK融合器(静态组)33例。随访2年以上。比较两组患者手术前后的临床疗效评价指标和影像学数据,并最终通过Bridwell标准椎间融合分级及融合器沉降程度Marchi分级,计算腰椎椎间融合器融合率及沉降率。结果可撑开组与静态组的患者一般资料差异无统计意义(P>0.05)。两组手术时间、术中失血量、术后引流量、术后住院时间以及术后并发症等围手术期指标差异无统计学意义(P>0.05)。两组术后各个时间段的腰痛、腿痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)较术前明显改善(P<0.05);组间各时间段差异无统计学意义(P>0.05)。在末次随访的影像学指标中,两组的骨盆入射角较术前差异均无统计学意义(均P>0.05)。两组术后椎间隙的高度、椎管面积和腰椎前凸角等相关影像学指标均较术前明显改善(P<0.05),组间差异无统计学意义(P>0.05)。可撑开组融合器的椎间融合率(94.9%)与静态组融合率(93.9%)差异无统计学意义(χ^(2)=0.030,P=0.863),可撑开组融合器沉降率(17.9%)与静态组沉降率(18.2%)差异无统计学意义(χ^(2)=0.001,P=0.980)。结论PE-PLIF置入可撑开融合器能够达到与传统静态融合器同样的治疗效果,有助于减轻患者临床症状以及恢复脊柱的生理曲度,为未来临床的治疗提供参考意见。Objective To investigate the clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion(PE-PLIF)with a titanium alloy fusion for the lumbar degenerative diseases.Methods The data of 72 patients with lumbar degenerative diseases who were treated with PE-PLIF in the Department of Spinal Surgery,Third Hospital of Shanxi Medical University from May 2019 to July 2021 were retrospectively analyzed.Among them,39 patients were implanted with a spread-open titanium alloy fusion device(spread-open group)and 33 cases were static PEEK fusion device(static group).The follow-up was more than 2 years.The clinical efficacy evaluation indexes and imaging data of the two groups were compared before and after surgery.Finally,the fusion rate and subsidence rate of lumbar interbody fusion were calculated using the Bridwell standard interbody fusion scale and the Marchi fusion degree scale.Results There was no statistical significance in the general data between the extendible group and the static group(P>0.05).There was no statistical significance in perioperative indexes such as operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital stay and postoperative complications between the two groups(P>0.05).The visual analogue scale(VAS)and Oswestry disability index(ODI)of lower back pain and leg pain were significantly improved in both groups at various time periods after surgery(P<0.05).There was no statistical significance in each time period between groups(P>0.05).In the imaging indicators of the last follow-up,there were no significant differences in the pelvic incidence angle between the two groups compared with the preoperative level(P>0.05).The postoperative imaging indicators such as the height of the vertebral space,vertebral canal area and lumbar lordosis angle were significantly improved between the two groups compared with the preoperative level(P<0.05),with no statistical significance between the two groups(P>0.05).There was no significant difference between the interb

关 键 词：内窥镜 脊柱融合术 腰椎 

分 类 号：R681.5[医药卫生—骨科学]