单侧双通道内镜下经椎间孔腰椎椎间融合术36例临床疗效观察  

Clinical efficacy of transforaminal lumbar interbody fusion of 36 cases under unilateral biportal endoscopy

作　　者：李杰[1] 朱宇[1] 李毅[1] 李高磊 黎少言 樊晓韩 卢文龙 Li Jie;Zhu Yu;Li Yi;Li Gaolei;Li Shaoyan;Fan Xiaohan;Lu Wenlong(Department of Orthopaedics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院骨科二病区,郑州450014

出　　处：《中华实验外科杂志》2024年第6期1320-1324,共5页Chinese Journal of Experimental Surgery

基　　金：河南省卫生健康委员会项目 河南省医学科技攻关计划(20230331)。

摘　　要：目的探讨单侧双通道内镜(UBE)下经椎间孔腰椎椎间融合术治疗腰椎退变性疾病的临床效果。方法选取郑州大学第二附属医院2021年3月至2023年12月收治的腰椎退变性疾病患者85例,其中UBE手术组36例,行UBE下腰椎减压、经皮固定、经椎间孔腰椎椎间融合术,开放手术组49例,行传统腰椎减压固定、椎体间植骨融合术。其中男40例,女45例;年龄52~74岁,平均62.3岁。比较两组患者手术相关指标(手术时间、术中出血量、术后引流量、住院时间、并发症发生率)、血清学指标(肌酸激酶、C反应蛋白)、临床疗效评价[手术前后疼痛视觉模拟评分(VAS)评分、腰痛疗效日本骨科协会(JOA)评分、腰椎融合率]。组间计量资料比较采用t检验,计数资料采用χ2检验。结果患者获随访区间4~12个月,随访(7.4±3.2)个月。UBE手术组在手术时间、术中出血量、术后引流量、住院时间方面低于开放手术组,差异有统计学意义[UBE组:(127.14±25.25)min、(132.78±47.43)ml、(37.54±10.62)ml、(7.42±0.77)d;开放组:(164.17±26.12)min、(280.61±47.67)ml、(50.19±22.35)ml、(10.71±1.73)d,t=7.549、-14.169、7.904、-10.663,P<0.05]。UBE手术组在术后1、3 d肌酸激酶、C反应蛋白水平低于开放手术组,差异有统计学意义[UBE组:(178.02±67.34)U/L、(93.46±35.27)U/L、(20.25±15.34)mg/L、(17.64±13.32)mg/L;开放组:(296.22±94.76)U/L、(152.43±40.51)U/L、(31.82±27.53)mg/L、(24.67±17.24)mg/L,t=-10.287、-9.528、-7.861、-8.982,P<0.05]。两组在并发症发生率、手术前后疼痛VAS评分、腰痛JOA评分、术后7 d肌酸激酶、C反应蛋白水平、腰椎融合率方面比较,差异无统计学意义(P>0.05)。UBE组出现1例神经根牵拉伤,治疗后恢复。结论UBE下经椎间孔腰椎椎间融合术可有效治疗腰椎退变性疾病,具有手术创伤小、出血量少、术后恢复快等优点,值得临床推广。Objective To evaluate the clinical efficacy of transforaminal lumbar interbody fusion under unilateral biportal endoscopy(UBE)in the treatment of lumbar degenerative diseases.Methods In total,85 patients with lumbar degenerative diseases were selected in the Second Affiliated Hospital of Zhengzhou University from March 2021 to December 2023.A total of 36 cases in the UBE group were treated with unilateral biportal endoscopic lumbar decompression,percutaneous fixation,transforaminal lumbar interbody fusion with bone graft.The rest 49 cases in the open group were treated with traditional lumbar decompression and fixation and interbody fusion.There were 40 males and 45 females,aged from 52 to 74 years with an average of 62.3 years.The surgical related indicators(surgical time,intraoperative bleeding volume,postoperative drainage volume,length of hospital stay,incidence of complications),serological indicators(creatine kinase,C-reactive protein),and clinical efficacy evaluation(VAS score for preoperative and postoperative pain,JOA score for lower back pain efficacy,and lumbar fusion rate)were compared between two groups.T test andχ2 test were used to compare the measurement data between groups.Results The patients were followed up for 4-12 months(mean 7.4±3.2 months).The surgical time,intraoperative bleeding volume,postoperative drainage volume and length of hospital stay in UBE group were significantly reduced as compared with those in open surgery group[UBE group:(127.14±25.25)min,(132.78±47.43)ml,(37.54±10.62)ml,(7.42±0.77)d;open surgery group:(164.17±26.12)min,(280.61±47.67)ml,(50.19±22.35)ml,(10.71±1.73)d,t=7.549,-14.169,7.904,-10.663,P<0.05].The levels of creatine kinase and C-reactive protein in the UBE group were significantly lower than those in the open surgery group on the 1st and 3rd day after operation[UBE group:(178.02±67.34)U/L,(93.46±35.27)U/L,(20.25±15.34)mg/L,(17.64±13.32)mg/L;open surgery group:(296.22±94.76)U/L,(152.43±40.51)U/L,(31.82±27.53)mg/L,(24.67±17.24)mg/L,t=-10.287,-9.52

关 键 词：单侧双通道内镜 经椎间孔腰椎融合 椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]