内镜与小切口经椎间孔腰椎间融合翻修术比较  

Comparison of endoscopic versus small-incision transforaminal lumbar interbody fusion revisions

作　　者：蒙觉威 陈勇喜[2] 覃海飚[2] 郭圣挥 覃忠设 刘科第 崔善林 范俊鸿 李品元 MENG Jue-wei;CHEN Yong-xi;QIN Hai-biao;GUO Sheng-hui;QIN Zhong-she;LIU Kedi;CUI Shan-lin;FAN Jun-hong;LI Ping-yuan(Guangxi University of Traditional Chinese Medicine,Nanning 530200,Guangxi,China;The First Affiliated Hospital,Guangxi University of Traditional Chinese Medicine,Nanning 530003,Guangxi,China;Hengzhou Hospital of Traditional Chinese Medicine,Nanning 530399,Guangxi,China)

机构地区：[1]广西中医药大学,广西南宁530200 [2]广西中医药大学第一附属医院,广西南宁530003 [3]横州市中医医院,广西南宁530399

出　　处：《中国矫形外科杂志》2024年第23期2113-2119,共7页Orthopedic Journal of China

基　　金：广西中医药适宜技术开发与推广项目(编号:GZSY23-28);广西中医药大学校级课题项目(编号:2022MS043)。

摘　　要：【目的】比较内镜下经椎间孔入路腰椎椎间融合术(endoscopic transforaminal lumbar interbody fusion,Endo-TLIF)与微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)单节段腰椎翻修术的疗效。【方法】回顾性分析2016年10月--2022年1月在本院脊柱外科接受单节段腰椎翻修手术60例患者的临床资料,根据医患沟通结果,30例采用行Endo-TLIF术翻修(内镜组),30例采用MIS-TLIF术翻修(小切口组),比较两组围手术期、随访及影像学资料。【结果】内镜组手术时间【(163.0±11.4)min vs(187.8±10.9)min,P<0.001】、切口总长度【(6.0±0.2)cm vs(7.2±0.8)cm,P<0.001】、术中出血量【(88.3±10.5)ml vs(110.2±11.7)ml,P<0.001】、术中透视次数【(6.0±1.5)次vs(8.0±1.3)次,P<0.001】、下地行走时间【(3.1±1.8)d vs(5.7±2.1)d,P<0.001】、住院天数【(4.9±1.5)d vs(7.9±2.6)d,P<0.001】均显著优于小切口组。两组术中并发症发生率的差异无统计学意义(P>0.05)。两组患者均获12个月以上随访,内镜组恢复完全负重活动时间显著早于小切口组【(28.2±3.9)d vs(35.7±6.5)d,P<0.001】。随时间推移,两组腰痛、腿痛VAS和0DI评分均显著减少(P<0.05)。术后3个月,内镜组腰痛VAS【(2.9±1.3)vs(4.1±1.7),P=0.006】、腿痛VAS【(2.4±1.2)vs(3.2±1.3),P=0.026】和ODI评分【(10.7±3.1)vs(14.1±5.1),P=0.003】均显著优于小切口组。影像方面,术后两组椎管面积、椎间隙高度明显增加(P<0.05),相应时间点,两组间上述影像指标及融合分级的差异均无统计学意义(P>0.05)。【结论】对于单节段腰椎翻修,Endo-TLIF能获得与MIS-TLIF具有相同的治疗效果,并且,Endo-TLIF创伤更小、并发症更少、术后恢复更快、安全性更高。【Objective】To compare the clinical outcomes of endoscopic transforaminal lumbar interbody fusion(Endo-TLIF)versus minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for single-segment lumbar revision.【Methods】A retrospective study was conducted on 60 patients who underwent single-level lumbar revision surgery in the spinal surgery department of our hospital from October 2016 to January 2022.According to doctor-patient communication,30 patients underwent Endo-TLIF revision,whereas other 30 patients underwent MIS-TLIF revision.The perioperative period,follow-up and imaging data of the two groups were compared.【Re-sults】The endo-TLIF group proved significantly superior to the MIS-TLIF group in terms of operation time【(163.0±11.4)min vs(187.8±10.9)min,P<0.001】,total incision length【(6.0±0.2)cm vs(7.2±0.8)cm,P<0.001】,blood loss【(88.3±10.5)ml vs(110.2±11.7)ml,P<0.001】,intraoperative fluoroscopy times【(6.0±1.5)times vs(8.0±1.3)times,P<0.001】,ambulation time【(3.1±1.8)days vs(5.7±2.1)days,P<0.001】,hospitalization days【(4.9±1.5)days vs(7.9+2.6)days,P<0.001】,however,there was no significant difference in the incidence of in-traoperative complications between the two groups(P>0.05).Patients in both groups were followed up for more than 12 months,and those in the Endo-TLIF group regained full weight-bearing activities significantly earlier than that in the MIS-TLIF group【(28.2±3.9)days vs(35.7±6.5)days,P<0.001】.The VASs both for lower back pain and leg pain,as well as ODI significantly decreased in both groups over time(P<0.05).The Endo-TLIF was significantly better than the MIS-TLIF in terms low back pain VAS【(2.9±1.3)vs(4.1±1.7),P=0.006】,legpain VAS【(2.4±1.2)vs(3.2±1.3),P=0.026】and 0DI scores【(10.7±3.1)vs(14.1±5.1),P=0.003】3 months postoperatively.As for imaging,the vertebral canal area and intervertebral space height were significantly increased in both groups after surgery compared with those preoperatively(P<0.05),whereas there were no

关 键 词：腰椎翻修 内镜下手术 微创手术 经椎间孔椎体间融合术 

分 类 号：R687[医药卫生—骨科学]