全可视化内镜下后外侧经关节突入路腰椎椎间融合术治疗退行性腰椎滑脱症  

Degenerative lumbar spondylolisthesis treated by posterolateral transarticular puncture lumbar interbody fusion under full visual endoscopy

作　　者：熊亮 赵红卫[1] 罗茗刈[1] 刘丰平[1] 卢斌[1] 邓宇翔 XIONG Liang;ZHAO Hong-wei;LUO Ming-yi;LIU Feng-ping;LU Bin;DENG Yu-xiang(Department of Spine Surgery,Yichang Central People's Hospital,the First College of Clinical Science,China Three Gorges University,Yichang 443008,Hubei,China)

机构地区：[1]三峡大学第一临床医学院宜昌市中心人民医院,湖北宜昌443008 [2]枝江市人民医院骨科,湖北枝江443299

出　　处：《中国骨伤》2024年第12期1145-1152,共8页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨全可视化内镜下后外侧经关节突入路腰椎椎间融合术(percutaneous endoscopic posterolateral trans-facet lumbar interbody fusion,PE-PTLIF)治疗退行性腰椎滑脱症(degenerative lumbar spondylolisthesis,DLS)的临床疗效。方法:回顾性分析2019年12月至2021年6月采用PE-PTLIF治疗的38例DLS患者的临床资料,男18例,女20例;年龄39~75(60.2±8.9)岁;L_(3,4)1例,L_(4,5)23例,L_(5)S_(1)14例;腰椎滑脱根据Meyerding分度,Ⅰ度29例,Ⅱ度9例。观察手术时间、术中出血量、引流量、住院时间及并发症情况,分别于术前、术后3d及术后3、6、12个月采用视觉模拟评分(visual analogue scale,VAS)评估腰腿疼痛程度,并于术前及术后3、6、12个月采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价下腰痛功能障碍程度。术后12个月时使用改良MacNab标准评估临床疗效。比较术前和术后12个月硬膜囊横截面积(dural sac cross-sectional area,DSCSA)、椎间隙高度(intervertebral disc height,IDH)、腰椎滑脱率(lumbar spondylolisthesis rate,SR)、腰椎前凸角(lumbar lordosis angle,LL)、手术节段前凸角(segmental lordosis angle,SL);根据Bridwell椎间融合标准评估术后12个月时的椎间融合情况。结果:所有患者获得随访,时间13~28(18.47±4.12)个月。手术时间(181.68±19.34)min,术中出血量(152.87±57.03)ml,引流量(48.18±11.43)ml,术后住院时间(9.45±2.18)d,3例出现并发症。术前、术后3d及术后3、6、12个月时的腰痛VAS分别为(6.68±1.16)、(4.32±1.13)、(2.18±0.70)、(1.89±0.56)和(1.57±0.72)分;腿痛VAS分别为(6.24±1.42)、(2.95±1.09)、(1.76±0.71)、(1.68±0.74)和(1.26±0.69)分;术前及术后3、6、12个月时的ODI分别为(63.21±11.21)%、(25.24±6.46)%、(20.97±6.26)%和(17.73±5.88)%;术后各时间点腰腿痛VAS、ODI评分均较术前明显降低(P<0.05)。术后12个月根据改良MacNab标准,优23例,良10例,可3例,差2例。术后12个月DSCSA、IDH、SR、LL和SL分别为(128.32±Objective To explore clinical effect of percutaneous endoscopic posterolateral trans-facet lumbar interbody fusion(PE-PTLIF)in treating degenerative lumbar spondylolisthesis.Methods The data of 38 patients with degenerative lumbar spondylolisthesis treated with PE-PTLIF from December 2019 to June 2021 were retrospectively analyzed,including 18 males and 20 females,aged from 39 to 75 years old with an average of(60.2±8.9)years old;1 patient with L_(3,4),23 patients with L_(4,5),14 patients with L_(5)S_(1);29 patients with degreeⅠand 9 patients with degreeⅡaccording to Meyerding grading.Operative time,intraoperative blood loss,drainage volume,postoperative hospital stay and complcations were observed,visual analogue scale(VAS)was used to evaluate degree of lumbar and leg pain before operation,3 d and 3,6 and 12 months after operation,respectively.Oswestry disability index(ODI)was used to evaluate degree of low back pain dysfunction before operation,3,6 and 12 months after operation. The modified MacNab standard was used to evaluate clinical efficacy at 12 months after operation. Dural sac cross-sectional area (DSCSA),intervertebral disc height (IDH),lumbar spondylolisthesis rate (SR),lumbar lordosis angle (LL) and segmental lordosis angle (SL) were compared before operation and 12 months after operation. Interbody fusion at 12 months was evaluated according to Bridwell intervertebral fusion standard. Results All patients were followed up for 13 to 28 months with an average of (18.47±4.12) months. The operative time was (181.68±19.34) min,intraoperative blood loss was (152.87±57.03) ml,drainage volume was (48.18±11.43) ml,and postoperative hospital stay was (9.45±2.18) d and 3 patients occurred complications. VAS of lumbar pain before operation,3 days,3,6 and 12 months after operation were (6.68±1.16),(4.32±1.13),(2.18±0.70),(1.89±0.56) and (1.57±0.72),respectively. VAS of leg pain were (6.24±1.42),(2.95±1.09),(1.76±0.71),(1.68±0.74) and (1.26±0.69) respectively. Preoperative and postoperative 3,

关 键 词：全可视化内镜技术 腰椎融合术 退行性腰椎滑脱症 临床疗效 

分 类 号：R681.5[医药卫生—骨科学]