精准内镜与微创减压融合治疗多节段腰椎管狭窄症  

Precise endoscopic decompression and instrumented fusion versus small-incision counterpart for multi-segmental lumbar spinal stenosis

作　　者：潘其鹏 孔凡国 付拴虎 王文举 张昌盛 朱卉敏 赵文海[3] 史明 PAN Qi-peng;KONG Fan-guo;FU Shuan-hu;WANG Wen-ju;ZHANG Chang-sheng;ZHU Hui-min;ZHAO Wenhai;SHI Ming(Department of Mininlally Invasive Spine Surgery,Orthopedic Hospital of Henan Province(Luoyang Orthopedic Hospital of Henan Province),Zhengzhou Henan 450016,China;Department of Spinal Surgery,First Affiliated Hospital,Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi 530023,China;Department of Orthopedics,the First Affiliated Hospital,Changchun University of Traditional Chinese Medicine,Changchun,Jilin 130021,China;Department of Bone,Joint and Spine Surgery,International Zhuang Medical Hospital,Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi 530023,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)脊柱微创外科,河南郑州450016 [2]广西中医药大学第一附属医院脊柱外科,广西南宁530023 [3]长春中医药大学第一附属医院骨伤科,吉林长春130021 [4]广西中医药大学附属国际壮医医院骨关节与脊柱科,广西南宁530023

出　　处：《中国矫形外科杂志》2024年第17期1558-1563,共6页Orthopedic Journal of China

基　　金：河南省中医药科学研究专项课题(编号:2024ZY3072);广西医疗卫生适宜技术开发与推广应用项目(编号:S2022060)。

摘　　要：[目的]比较单侧双通道内镜下经椎间孔腰椎间融合术(unilateral biportal endoscopy transforaminal lumbar interbody fusion,UBE-TLIF)和微创经椎间孔腰椎间融合(minimal invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)的临床效果。[方法]回顾性分析2022年1月—2023年8月本院基于神经阻滞定位的微创手术治疗多节段腰椎管狭窄症52例患者的临床资料。依据术前医患沟通结果,28例采用UBE-TLIF治疗;24例采用MIS-TLIF治疗。比较两组患者围手术期、随访和影像资料。[结果]两组均顺利完成手术,无死亡及神经损伤等严重并发症发生。UBE-TLIF组在手术时间[(137.7±24.6)min vs(154.8±34.5)min,P=0.042]、术中出血量[(182.5±33.2)ml vs(211.7±57.4)ml,P=0.027]、下床时间[(2.4±0.5)d vs(3.3±0.4)d,P<0.001]、住院时间[(7.3±1.4)d vs(8.4±2.1)d,P=0.042]均显著优于MIS-TLIF组。所有患者随访(10.6±1.9)个月,随时间推移,两组的VAS评分、ODI和JOA评分均显著改善(P<0.05);相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,术后两组硬膜囊面积、责任节段椎间隙高度较术前均显著改善(P<0.05);但相应时间点,两组间影像指标的差异均无统计学意义(P>0.05)。末次随访时,UBE-TLIF组融合率为89.3%,MIS-TLIF组为91.7%,差异无统计学意义(P>0.05)。[结论]精准模式微创减压固定融合治疗多节段腰椎管狭窄症,可显著减少手术创伤和患者经济负担。两种术式均可取得满意临床疗效,相比之下,UBE-TLIF组在手术时间、术中出血量、下床时间、住院时间优于MIS-TLIF组。[Objective]To compare clinical consequences of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF)versus minimal invasive transforaminal lumbar interbody fusion(MIS-TLIF)for multi-segment lumbar spinal stenosis(LSS).[Methods]A retrospective analysis was performed on 52 patients who received accurate minimal invasive surgery based on nerve block location for multi-level LSS in our hospitals from January 2022 to August 2023.According to preoperative doctor-patient communication,28 patients were treated with UBE-TLIF,while other 24 patients underwent MIS-TLIF.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had operation performed successfully without serious complications,such as death and nerve injury.The UBE-TLIF group proved significantly superior to the MIS-TLIF group in terms of operative time[(137.7±24.6)min vs(154.8±34.5)min,P=0.042],intraoperative blood loss[(182.5±33.2)ml vs(211.7±57.4)ml,P=0.027],bed rest time[(2.4±0.5)days vs(3.3±0.4)days,P<0.001],hospital stay[(7.3±1.4)days vs(8.4±2.1)days,P=0.042].As time went on during follow-up period lasted for(10.6±1.9)months in a mean,the VAS,ODI and JOA scores in both groups were significantly improved(P<0.05),whereas which were not statistically significant between the two groups at any corresponding time points(P>0.05).As for imaging,the area of internal dural sac and height of intervertebral space at the responsible level were significantly improved in both groups after surgery(P<0.05),while which were not significantly different between the two groups at any time points accordingly(P>0.05).At the last follow-up,the intervertebral fusion rate was of 89.3%in the UBE-TLIF group,while 91.7%in the MIS-TLIF group,and the difference was not statistically significant(P>0.05).[Conclusion]The accurate minimally invasive decompression and instrumented fusion in the treatment of multi-level lumbar spinal stenosis do significantly reduce surgical trauma and patients'econo

关 键 词：多节段腰椎管狭窄症 神经根阻滞术 单侧双通道内镜腰椎间融合术 微创经椎间孔腰椎间融合 

分 类 号：R681.57[医药卫生—骨科学]