腰椎退行性病双通道内镜与开放椎间融合比较  

Biportal endoscopic lumbar interbody fusion versus open counterpart for lumbar degenerative diseases

作　　者：慈吉辰 汲长蛟[2] 张建新 孔鹏[2] 翟钰泽[1] 宫宸 孙昌宇 申素昊 牟海波 CI Ji-chen;JI Chang-jiao;ZHANG Jian-xin;KONG Peng;ZHAI Yu-ze;GONG Chen;SUN Chang-yu;SHEN Su-hao;MOU Hai-bo(The FirstClinical Medical School,Shandong University of Traditional Chinese Medicine,Jinan 250000,China;Department of Minimally InvasiveOrthopedics,Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Jinan 250000,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250000 [2]山东中医药大学附属医院微创骨科,山东济南250000

出　　处：《中国矫形外科杂志》2024年第15期1352-1358,共7页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:82204876)。

摘　　要：[目的]比较双通道脊柱内镜下椎间融合术(biportal endoscopic lumbar interbody fusion,BE-LIF)与传统半椎板切除腰椎椎间融合术(hemilamiectomy and lumbar interbody fusion,HL-LIF)治疗腰椎退行性疾病的临床疗效。[方法]回顾性分析2022年3月—2022年11月在本院手术治疗的腰椎退行性疾病78例患者的临床资料。按照医患沟通结果,35例采用BELIF,41例采用HL-LIF。比较两组围手术期、随访及辅助检查等资料。[结果]虽然BE-LIF组手术时间显著长于HL-LIF组,但BE-LIF组切口长度[(7.1±1.0)cm vs(11.5±2.2)cm,P<0.001]、术中失血量[(240.0±121.2)ml vs(344.9±140.9)ml,P<0.001]、下地时间[(3.2±0.5)d vs(4.4±0.5)d,P<0.001]均显著优于HL-LIF组。平均随访时间(15.8±2.3)个月,随时间推移,两组的VAS、ODI、JOA评分均显著改善(P<0.05)。术后5个月时,BE-LIF组的腰痛VAS[(1.4±0.5)vs(1.8±0.7),P=0.005]、ODI[(15.3±2.5)vs(16.7±3.2),P=0.039]、JOA评分[(25.3±1.0)vs(24.2±1.5),P<0.001]均显著优于HL-LIF组。影像方面,两组术后椎间隙高度、腰椎前凸角度均较术前显著增加(P<0.05)。各时间点两组椎间隙高度、腰椎前凸角、椎间融合Bridwell等级的差异无统计学意义(P>0.05)。[结论]两种术式均取得良好的临床疗效。BE-LIF较HL-LIF手术创伤小,术后早期腰部疼痛轻,功能恢复速度快。[Objective]To compare clinical efficacy of biportal endoscopic lumbar interbody fusion(BE-LIF)versus conventional hemilamiectomy lumbar interbody fusion(HL-LIF)for degenerative lumbar diseases.[Methods]A retrospective study was done on 78 patients who received surgical treatment for lumbar degenerative diseases in our hospital from March 2022 to November 2022.According to the results of doctor-patient discussion,35 patients received BE-LIF,while other 41 patients underwent HL-LIF.The perioperative period,follow-up and auxiliary examination were compared between the two groups.[Results]Although the BE-LIF cohort consumed significantly longer operative time than the HL-LIF cohort,the former proved significantly superior to the latter in terms of incision length[(7.1±1.0)cm vs(11.5±2.2)cm,P<0.001],intraoperative blood loss[(240.0±121.2)ml vs(344.9±140.9)ml,P<0.001],postoperative walking time[(3.2±0.5)days vs(4.4±0.5)days,P<0.001].With time of the follow-up lasted for(15.8±2.3)months in a mean,the VAS,ODI and JOA scores in both groups significantly improved(P<0.05).The BE-LIF group was significantly better than the HL-LIF group in terms of low back pain VAS[(1.4±0.5)vs(1.8±0.7),P=0.005],ODI[(15.3±2.5)vs(16.7±3.2),P=0.039]and JOA score[(25.3±1.0)vs(24.2±1.5),P<0.001]5 months after surgery.As for imaging,the intervertebral space height and the lumbar lordosis were significantly increased in both groups after surgery(P<0.05).However,there were no significant differences in intervertebral space height,lumbar lordosis and intervertebral fusion Bridwell grade between the two groups at any time points accordingly(P>0.05).[Conclusion]Both of the lumbar fusion methods achieved good clinical outcomes.By comparison,the BE-LIF takes advantage of minimally invasive surgery,with less pain in early stage after operation and faster function recovery over the HL-LIF.

关 键 词：腰椎退行性疾病 双通道脊柱内镜下椎间融合术 半椎板切除腰椎椎间融合术 

分 类 号：R681.5[医药卫生—骨科学]