低度腰椎滑脱症经皮内镜与切开腰椎间融合比较  

Percutaneous endoscopic lumbar fusion versus open counterpart for low grade lumbar spondylolisthesis

作　　者：徐用亿[1] 王守国[1] 费昊东[1] 陈政[1] 陈晓钢 唐洪辉[1] XU Yong-yi;WANG Shou-guo;FEI Hao-dong;CHEN Zheng;CHEN Xiao-gang;TANG Hong-hui(The First Hospital of Huaian City,Nanjing Medical University,Huaian 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院,江苏淮安223300

出　　处：《中国矫形外科杂志》2024年第13期1181-1187,共7页Orthopedic Journal of China

摘　　要：[目的]比较分析经皮大通道脊柱内镜(percutaneous endoscopic lumbar interbody fusion,PELIF)与切开后路腰椎间融合术(posterior lumbar interbody fusion,PLIF)治疗单节段低度腰椎滑脱症的临床疗效。[方法]回顾性分析2020年1月—2023年2月本院手术治疗的56例单节段低度腰椎滑脱症患者的临床资料。根据术前医患沟通结果,27例接受PELIF;另外29例接受PLIF治疗。比较两组围手术期资料、随访结果和影像学资料。[结果]PELIF组切口总长度[(8.3±1.5)cm vs(10.2±2.2)cm,P<0.001]、术中失血量[(151.9±99.5)ml vs(303.5±117.2)ml,P<0.001]、开始下地行走时间[(2.2±0.9)d vs(3.3±0.9)d,P<0.001]、住院时间[(5.9±1.8)d vs(8.6±2.3)d,P<0.001]均显著优于PLIF组,PELIF组手术时间[(178.3±32.5)min vs(134.5±27.4)min,P<0.001]和术中透视次数[(34.3±7.1)次vs(12.0±4.0)次,P<0.001]显著大于PLIF组;两组术中并发症率和切口愈合等级的差异无统计学意义(P>0.05)。56例平均随访时间(16.3±2.6)个月。随时间推移,两组腰痛VAS评分、腿痛VAS评分、ODI、JOA评分均显著改善(P<0.05)。术后第3 d PELIF组的腰VAS评分显著低于PLIF组[(2.6±1.9)vs(4.0±1.8),P=0.005],但是,相应时间点两组腿痛VAS评分、ODI、JOA评分组间比较差异无统计学意义(P>0.05)。影像方面,术后两组腰椎前凸角、椎间隙高度、滑脱率、椎管面积均较术前显著改善(P<0.05),相应时间点,两组组间比较差异无统计学意义(P>0.05)。[结论]采用PELIF与开放PLIF治疗低度腰椎滑脱症都可以取得令人满意的疗效,但PELIF具有创伤小、术后早期腰痛缓解快优点。[Objective]To compare the clinical efficacy of percutaneous endoscopic lumbar interbody fusion with large channel(PE⁃LIF)versus open posterior lumbar interbody fusion(PLIF)for single-level and low-grade lumbar spondylolisthesis.[Methods]A retrospec⁃tive study was conducted on 56 patients who received lumbar fusion for the single-level and low-grade lumbar spondylolisthesis in our hos⁃pital from January 2020 to February 2023.According to preoperative dock-patient communication,27 patients underwent PELIF,while oth⁃er 29 patients received PLIF.The perioperative,follow-up and imaging data were compared between the two groups.[Results]The PELIF group proved significantly superior to the PLIF group in terms of total incision length[(8.3±1.5)cm vs(10.2±2.2)cm,P<0.001],intraopera⁃tive blood loss[(151.9±99.5)ml vs(303.5±117.2)ml,P<0.001],time to return walking[(2.2±0.9)days vs(3.3±0.9)days,P<0.001],hospital⁃ization[(5.9±1.8)days vs(8.6±2.3)days,P<0.001],despite of the fact that the former was significantly inferior to the latter in terms of opera⁃tive time[(178.3±32.5)min vs(134.5±27.4)min,P<0.001]and intraoperative fluoroscopy times[(34.3±7.1)times vs(12.0±4.0)times,P<0.001].There was no significant difference in intraoperative complication rate and incision healing grade between the two groups(P>0.05).As time went on during follow-up period lasted for(16.3±2.6)months,VAS score for leg pain,VAS score for back pain,ODI score and JOA score significantly improved in both groups(P<0.05).The PELIF group had significantly lower lumbago VAS score than the PLIF group 3 days postoperatively[(2.6±1.9)vs(4.0±1.8),P=0.005],whereas there were no significant differences in the leg pain VAS score,ODI and JOA scores between the two groups at any time points accordingly(P>0.05).As for imaging,the lumbar lordosis angle,intervertebral space height,slipping rate and spinal canal area significantly improved in both groups after surgery compared with those preoperatively(P<0.05),while which were not statistically

关 键 词：腰椎滑脱 脊柱内镜 椎体间融合 经皮技术 

分 类 号：R687[医药卫生—骨科学]