单孔分体内镜微创技术联合经皮椎弓根螺钉内固定治疗单节段退行性腰椎不稳的早期临床疗效分析  

Early clinical efficacy analysis of single port endoscopic minimally invasive technique combined with percutaneous pedicle screw fixation for the treatment of single segment degenerative lumbar instability

作　　者：薛皓 刘成洲 于鹏 朱腾月 XUE Hao;LIU Cheng-zhou;YU Peng;ZHU Teng-yue(Department of Spinal Surgery,Juye County People’s Hospital,Heze,Shandong 274900,China;Department of Spinal Surgery,Linqu County People's Hospital,Weifang,Shandong 262600,China;The Sixth Medical Center of the People's Liberation Army General Hospital,Beijing 100048,China)

机构地区：[1]山东省巨野县人民医院脊柱外科,山东菏泽274900 [2]山东省临朐县人民医院脊柱外科,山东潍坊262600 [3]解放军总医院第六医学中心,北京100048

出　　处：《颈腰痛杂志》2024年第6期1061-1066,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：山东省医学会青年人才托举项目(编号:2023_JC_0021);山东省潍坊市青年医学人才托举项目(编号:潍卫字2024113)。

摘　　要：目的对比分析单孔分体内镜(OSE)微创技术联合经皮椎弓根螺钉内固定与开放腰椎后路椎间融合术(PLIF)治疗单节段退行性腰椎不稳的早期临床疗效。方法选取2021年5月至2023年4月收治的且符合选择标准的45例腰椎间盘突出伴退行性腰椎不稳患者,其中19例采用OSE术治疗(OSE组),26例手术方式为PLIF(PLIF组)。评价对比两组术中出血量、手术时间、术后48 h刀口引流量、术后住院时间及并发症等情况。采用VAS评分法和Oswestry功能障碍指数及SF-36评分,分别对两组患者术前、术后1周、术后1个月、术后3个月及末次随访的疼痛情况及功能恢复效果进行评价。结果所有病例均顺利完成手术,随访时间5~14个月,平均8.2个月,与PLIF组相比,OSE组手术时间较长,术中出血量、术后48 h刀口引流量及术后住院时间减少,差异有统计学意义(P<0.05)。两组术中无并发症发生,OSE组术后发生硬膜外血肿1例,下肢深静脉血栓形成1例,并发症发生率10.53%(2/19);PLIF组发生刀口浅表感染1例、硬膜外血肿1例,下肢深静脉静脉血栓形成4例,并发症发生率15.38%(4/26),所有并发症均经保守治疗后治愈,两组术后并发症发生率比较差异无统计学意义(χ^(2)=0.224,P=0.636)。两组术前VAS、ODI评分比较无明显差异(P>0.05),两组术后各时间点腰、腿痛VAS、ODI评分及SF-36量表评分均较术前明显改善(P<0.05);OSE组术后1周、1个月各指标优于PLIF组(P<0.05),术后3个月及末次随访时各指标比较两组间差异无统计学意义(P>0.05)。所有患者均无融合器松动、移位并发症的发生。末次随访时两组患者骨性融合正常。结论OSE技术联合经皮椎弓根螺钉内固定治疗单节段退行性腰椎不稳,术中操作灵活,创伤小,术后疗效与安全性与PLIF相当。虽然手术时间相对增加,但术后患者痛苦轻、住院时间短、病情恢复快,早期临床疗效满意。Objective To comparatively analyze the early clinical efficacy of one hole split endoscopy(OSE)combined with percutaneous pedicle screw fixation and open posterior lumbar interbody fusion(PLIF)in the treatment of single-segment degenerative lumbar instability.Methods 45 patients with lumbar disc herniation and degenerative lumbar instability who met the selection criteria and were admitted from May 2021 to April 2023 were selected.Among them,19 patients underwent OSE surgery(OSE group)and 26 patients underwent PLIF surgery(PLIF group).The intraoperative bleeding volume,surgical time,incision drainage volume at 48 hours after surgery,postoperative hospital stay,and complications were evaluated and compared between the two groups.The VAS scoring method,Oswestry Dysfunction Index,and SF-36 score were used to evaluate the pain and functional recovery effects of two groups of patients before,1 week,1 month,3 months,and the last follow-up,respectively.Results All cases successfully completed the surgery,with a follow-up time of 5-14 months,an average of 8.2 months.Compared with the PLIF group,the OSE group had a longer surgical time,reduced intraoperative bleeding,48hour postoperative incision drainage volume,and postoperative hospital stay,with statistical significance(P<0.05).There were no complications during the two groups of surgery.In the OSE group,there was 1 case of epidural hematoma and 1 case of deep vein thrombosis in the lower limbs after surgery,with a complication rate of 10.53%(2/19);One case of superficial infection at the incision site,one case of epidural hematoma,and four cases of deep vein thrombosis in the lower limbs occurred in the PLIF group,with a complication rate of 15.38%(4/26).All complications were cured after conservative treatment,and there was no statistically significant difference in the incidence of postoperative complications between the two groups(χ^(2)=0.224,P=0.636).There was no significant difference in preoperative VAS and ODI scores between the two groups(P>0.05).The VAS,ODI

关 键 词：单孔分体内镜 脊柱微创技术 椎弓根螺钉内固定 椎间融合 腰椎不稳 早期疗效 

分 类 号：R826.6[医药卫生—临床医学]