同轴全脊柱内镜辅助管状融合通道或叶片拉钩融合通道腰椎椎体间融合术  

A retrospective study comparing tubular fusion channel and bladed retractor fusion channel in full-endoscopic lumbar interbody fusion

作　　者：杨阳[1] 陈子豪 刘仲宇[1] 陈瑞强[1] 齐佳坤 董健文[1] 戎利民[1] Yang Yang;Chen Zihao;Liu Zhongyu;Chen Ruiqiang;Qi Jiakun;Dong Jianwen;Rong Limin(Department of Spine Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院脊柱外科,广东省微创脊柱外科质量控制中心,广东省微创脊柱外科工程技术研究中心,广州510630

出　　处：《中华骨科杂志》2025年第1期10-18,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用叶片拉钩通道系统与倒装设计工具实施全时同轴全脊柱内镜辅助腰椎椎体间融合术的可行性、安全性及临床疗效。方法回顾性分析2018年6月至2023年4月在中山大学附属第三医院接受同轴全脊柱内镜辅助腰椎椎体间融合术101例患者的资料,依据术中应用的融合通道类型分为管状通道组59例、叶片拉钩通道组42例,后者结合采用倒装设计工具实现脊柱内镜全时监视下减压、终板处理与椎间融合操作。比较两组手术时间、术中估计失血量(intraoperative estimated blood loss,IEBL)、并发症发生情况、椎体间融合率(Bridwell标准),比较术前、术后1周、末次随访时两组患者腰痛和下肢痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)评分、Oswestry功能障碍指数(Oswestry disability index,ODI),比较术前、术后1周融合节段的椎间隙高度。结果两组患者均得到随访,管状通道组随访时间为(42.9±12.1)个月,叶片拉钩通道组为(20.9±4.9)个月。两组患者手术时间、IEBL、并发症发生率、椎体间融合率(Bridwell标准1-2级)的差异均无统计学意义(P>0.05)。术后1周管状通道组单节段融合患者JOA评分和ODI分别为23(20,25)分和16%(11%,21%),均优于叶片拉钩通道组的20(18,23)和28%(21%,41%),差异有统计学意义(Z=3.020,P=0.003;Z=4.740,P<0.001);而管状通道组双节段融合患者JOA评分为23(20,25)分,优于叶片拉钩通道组的20(18,21)分,差异有统计学意义(Z=2.054,P=0.040)。末次随访时两组患者腰痛和下肢痛VAS评分、JOA评分及ODI的差异均无统计学意义(P>0.05)。术后1周两组患者的椎间隙高度均较术前提高(P<0.05),叶片拉钩通道组椎间隙高度为(1.46±0.28)cm,优于管状通道组的(1.17±0.20)mm,差异有统计学意义(t=5.947,P<0.001)。结论采用叶片拉钩融合通道与倒装设计工具实施全时同轴全脊柱内镜辅助腰椎椎体间融�Objective To evaluate the feasibility,safety,and clinical outcomes of full-time full-endoscopic lumbar interbody fusion(FELIF)using a bladed retractor fusion channel(BRFC)system with reversed-mounting designed instruments compared to a tubular fusion channel(TFC).Methods This retrospective study analyzed 101 cases of uniportal coaxial endoscopic lumbar interbody fusion performed between June 2018 and April 2023.Based on the type of fusion channel utilized,patients were divided into the TFC group(59 cases)and the BRFC group(42 cases).The BRFC technique involved neurological decompression,endplate preparation,and interbody fusion performed under full-time endoscopic monitoring with reversed-mounting designed instruments.Key parameters,including surgery duration,intraoperative estimated blood loss(IEBL),complication incidence,and interbody fusion rate(assessed by Bridwell criteria),were compared between the two groups.Clinical outcomes,including visual analog scale(VAS)scores for back and leg pain,Japanese Orthopaedic Association(JOA)scores,and Oswestry Disability Index(ODI),were recorded preoperatively,postoperatively,and at the final follow-up.Additionally,disc height at the fusion level was measured at one week postoperatively.Results The mean follow-up duration was 42.9±12.1 months in the TFC group and 20.9±4.9 months in the BRFC group.No statistically significant differences were observed between the two groups in terms of surgery duration,IEBL,complication incidence,or interbody fusion rate(Grade 1 or 2 by Bridwell criteria)(P>0.05).For single-level cases,the TFC group showed significantly better short-term clinical outcomes than the BRFC group at one week postoperatively,with JOA scores of 23(20,25)versus 20(18,23)(Z=3.020,P=0.003)and ODI scores of 16%(11%,21%)versus 28%(21%,41%)(Z=4.740,P<0.001).For double-level cases,the JOA score in the TFC group[23(20,25)]was also significantly better than that in the BRFC group[20(18,21)](Z=2.054,P=0.040)at one week postoperatively.However,at the final follow-up,all cl

关 键 词：腰椎 脊柱融合术 内窥镜检查 融合通道 

分 类 号：R68[医药卫生—骨科学]