腰椎侧隐窝狭窄症内镜减压与微创椎体间融合的比较  

Comparison of endoscopic decompression and minimally invasive interbody fusion for lumbar lateral recess stenosis

作　　者：谭芳 于涛 张锋 韩帅 李凯 张兴鹏 陈润芝 王健[1] TAN Fang;YU Tao;ZHANG Feng;HAN Shuai;LI Kai;ZHANG Xing-peng;CHEN Run-zhi;WANG Jian(Department of Orthopedics,People's Hospital of Shanghai Pudong New Area,Shanghai201299,China)

机构地区：[1]上海市浦东新区人民医院骨科,上海浦东201299

出　　处：《中国矫形外科杂志》2024年第15期1345-1351,共7页Orthopedic Journal of China

基　　金：上海市浦东新区学科建设重点学科项目(编号:PWZxk2022-16);国家自然科学基金青年基金项目(编号:82003132);上海市自然科学基金项目(编号:22ZR1455700);上海市浦东新区科技发展基金项目(编号:PKJ2022-Y37)。

摘　　要：[目的]比较经皮椎间孔内镜技术(percutaneous endoscopic lumbar discectomy,PELD)与微创经椎间孔椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MISTLIF)治疗腰椎侧隐窝狭窄症的临床疗效。[方法]回顾性分析62例腰椎侧隐窝狭窄症患者的临床资料,根据医患沟通结果,27例采用PELD治疗(减压组),35例采用MISTLIF治疗(融合组),比较两组围术期指标、随访和影像学结果。[结果]两组患者均顺利完成手术,未发生严重手术并发症。减压组手术用时[(54.4±11.4)min vs(104.4±10.5)min,P<0.001]、切口总长度[(0.9±0.1)cm vs(6.2±1.5)cm,P<0.001]、术中失血量[(38.5±18.8)ml vs(85.1±50.8)ml,P<0.001]、下地行走时间[(10.7±6.6)d vs(29.1±12.7)d,P<0.001]、住院天数[(6.1±1.6)d vs(8.5±2.6)d,P<0.001]均显著优于融合组。两组随访时间均超过12个月,减压组的患者完全负重活动时间显著早于融合组[(44.6±12.6)d vs(57.7±10.0)d,P<0.001]。随时间推移,两组患者腰痛、腿痛VAS和ODI评分均显著改善(P<0.05)。相应时间点,两组间上述评分的差异无统计学意义(P>0.05)。影像方面,与术前比较,末次随访时两组椎管面积和侧隐窝矢径均显著增加(P<0.05),而腰椎前凸角无显著变化(P>0.05)。术前两组上述指标的差异均无统计学意义(P>0.05)。末次随访时,减压组的椎管面积[(165.0±7.3)mm^(2)vs(201.5±12.9)mm^(2),P<0.001]、侧隐窝矢径[(4.1±0.4)mm vs(4.9±0.5)mm,P<0.001]均显著小于融合组,两组间腰椎前凸角的差异无统计学意义(P>0.05)。[结论]两种微创术式临床效果相当,但相比MISTLIF技术,应用单纯减压的PELD技术治疗腰椎侧隐窝狭窄症更微创,患者恢复更快。[Objective]To compare the clinical outcomes of percutaneous endoscopic lumbar discectomy(PELD)versus minimally inva⁃sive transforaminal lumbar interbody fusion(MISTLIF)for lumbar lateral recess stenosis.[Methods]A retrospective study was conducted on 62 patients who received surgical treatment for lumbar lateral recessional stenosis.According to the preoperative doctor-patient communica⁃tion,27 patients had spinal canal decompressed with PELD(the decompression group),while other 35 patients were treated with MISTLIF(the fusion group).The documents regarding to perioperative period,follow-up and images were compared between the two groups.[Results]All patients in both groups had operation performed successfully without serious surgical complications.The decompression group proved significantly superior to the fusion group in terms of operation time[(54.4±11.4)min vs(104.4±10.5)min,P<0.001],total incision length[(0.9±0.1)cm vs(6.2±1.5)cm,P<0.001],intraoperative blood loss[(38.5±18.8)ml vs(85.1±50.8)ml,P<0.001],postoperative walking time[(10.7±6.6)days vs(29.1±12.7)days,P<0.001]and hospital stay[(6.1±1.6)days vs(8.5±2.6)days,P<0.001].All patients in both groups were followed up for more than 12 months,and the decompression group resumed full weight-bearing activity significantly earlier than the fusion group[(44.6±12.6)days vs(57.7±10.0)days,P<0.001].The VAS scores for lower back pain and leg pain,as well as ODI score signifi⁃cantly declined over time in both groups(P<0.05),whereas which were not statistically significant between the two groups at any correspond⁃ing time points(P>0.05).Radiographically,the vertebral canal area and lateral recess diameter significantly increased in both groups at the last follow-up compared with those preoperatively(P<0.05),while the lumbar lordosis angle remained unchanged(P>0.05).Although there was no significant difference between the two groups before operation(P>0.05),the decompression group got significantly less spinal canal area[(165.0±7.3)mm^(2) vs(201.5

关 键 词：腰椎侧隐窝狭窄症 经皮椎间孔镜技术 微创经椎间孔椎体间融合术 回顾性研究 

分 类 号：R681.5[医药卫生—骨科学]