显微内窥镜下两种不同腰椎融合术的比较研究  

Comparative study of two different lumbar fusion under microendoscope

作　　者：张杨 王鹏 白明[1] 王俊峰[2] 李树文[1] 李志军 吴一民[1] Zhang Yang;Wang Peng;Bai Ming;Wang Junfeng;Li Shuwen;Li Zhijun;Wu Yimin(The Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,China;Orthopaedic Clinical Trial Center,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,China;Department of Anatomy,School of Basic Medicine,Inner Mongolia Medical University,Hohhot 010000,China)

机构地区：[1]内蒙古医科大学第二附属医院,呼和浩特010000 [2]内蒙古医科大学第二附属医院骨科临床试验中心,呼和浩特010000 [3]内蒙古医科大学基础医学院解剖学教研室(数字医学中心),呼和浩特010000

出　　处：《中国临床解剖学杂志》2024年第4期453-456,共4页Chinese Journal of Clinical Anatomy

基　　金：内蒙古自治区科技计划项目(2021GG0395);内蒙古医科大学“致远”人才计划(ZY0110019)。

摘　　要：目的分析比较显微内窥镜下两种不同腰椎椎间融合手术技术治疗单节段腰椎退变性疾病的临床疗效。方法选取我院2020年12月至2023年12月间符合标准的136例患者进行回顾性研究。75例患者接受显微内镜下经椎间孔入路椎体间融合术(microendoscopic tranforaminal lumbar interbody fusion,ME-TLIF),61例患者行显微内镜下经后方入路椎体间融合术(microendoscopic posterior lumbarinterbodyfusion,ME-PLIF)。对两组围手术期资料及神经系统并发症发生情况进行比较。在手术前后对组内和组间的疼痛(VAS)及功能(ODI)评分进行比较。采用Suk标准评价术后融合情况。结果ME-PLIF组患者在术中出血量、术后引流量、手术时间等指标方面,均优于ME-TLIF组。ME-PLIF组术中出现3例神经系统并发症,ME-TLIF组无神经系统并发症。同组患者术后VAS及ODI分值与术前相比较差异有统计学意义(P<0.05);组间术后VAS及ODI分值改变无统计学意义(P>0.05)。末次随访时两组融合率基本无差异。结论ME-PLIF技术在减少手术时间,降低术中及术后出血量方面更有优势,更容易学习掌握,在手术中要注意向外侧的充分减压防止神经并发症的发生。Objective To analyze and compare the clinical efficacy of two different lumbar interbody fusion techniques under microendoscope in the treatment of single level lumbar degenerative diseases.Methods A total of 136 patients who met the criteria in our hospital from December 2020 to December 2023 were selected for retrospective study.Seventy-five patients received microendoscopic tranforaminal lumbar interbody fusion(ME-TLIF)and 61 patients received microendoscopic posterior lumbar interbody fusion(MEPLIF).The perioperative data and the incidence of neurological complications were compared between the two groups.Pain(VAS)and function(ODI)scores within and between groups were compared before and after surgery.Suk criteria were used to evaluate postoperative fusion.Results The indexes of intraoperative blood loss,postoperative drainage volume and operation time in ME-PLIF group were better than those in METLIF group.There were 3 cases of neurological complications in the ME-PLIF group and no neurological complications in the ME-TLIF group.Postoperative VAS and ODI scores in the same group were significantly different from those before surgery(P<0.05);Postoperative VAS and ODI scores were not significantly changed between groups(P>0.05).There was no difference in the fusion rate between the two groups at the last follow-up.Conclusions ME-PLIF technique has more advantages in reducing operation time,intraoperative and postoperative blood loss,and is easier to learn and master.During the operation,attention should be paid to adequate lateral decompression to prevent the occurrence of neurological complications.

关 键 词：显微内窥镜 微创 后路腰椎融合 经椎间孔腰椎融合 退变性疾病 

分 类 号：R681.5[医药卫生—骨科学]