全可视内镜辅助后路经椎间孔与微创经椎间孔腰椎椎间融合术治疗单节段腰椎退行性疾病  

Comparison of the efficacy of fully visualized endoscopic posterior transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease

作　　者：陆龙卫 陈垚 徐佳隆 顾俊文 李晓亮 张海龙[2] 童培建[3] Lu Longwei;Chen Yao;Xu Jialong;Gu Junwen;Li Xiaoliang;Zhang Hailong;Tong Peijian(Department of Orthopaedics,Jiaxing Xuzhou District People's Hospital,Jiaxing 314015,China;Department of Spinal Surgery,Affiliated Tenth People's Hospital of Tongji University,Shanghai 200072,China;Department of Orthopaedics,Zhejiang Provincial Hospital of Chinese Medicine,Hangzhou 310006,China)

机构地区：[1]嘉兴市秀洲区人民医院(浙江省中医院秀洲分院)骨科,嘉兴314015 [2]同济大学附属第十人民医院脊柱外科,上海200072 [3]浙江省中医院骨伤科,杭州310006

出　　处：《中华骨科杂志》2025年第2期77-85,共9页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生科技计划项目(2025KY1630)。

摘　　要：目的:比较全可视内镜辅助后路经椎间孔腰椎椎间融合术(endoscopic posterior transforaminal lumbar interbody fusion,Endo-PTLIF)与微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗单节段腰椎退行性疾病的临床疗效。方法:回顾性分析2020年9月至2023年3月于嘉兴市秀洲区人民医院收治的56例单节段腰椎退行性疾病患者资料,按手术方式分为Endo-PTLIF组与MIS-TLIF组。Endo-PTLIF组24例,男11例、女13例,年龄(56.5±8.4)岁(范围43~72岁);MIS-TLIF组32例,男10例、女22例,年龄(54.5±10.4)岁(范围37~73岁)。比较两组患者围手术期指标、疼痛视觉模拟评分(visual analogue score,VAS)、Oswestry功能障碍指数(Oswestry dability index,ODI)、腰椎前凸角(lumbar lordosis,LL)、椎间隙高度(disc height,DH)及硬膜囊横截面积(dural sac cross sectional area,DSCA)。结果:两组患者一般资料、术前疼痛VAS评分、ODI、LL、DH及DSCA的差异均无统计学意义(P>0.05)。Endo-PTLIF组手术时间为(173.9±12.3)min,长于MIS-TLIF组的(136.5±19.5)min;透视次数为(15.9±1.8)次,多于MIS-TLIF组的(13.0±1.6)次;术中出血量为(68.9±12.9)ml,少于MIS-TLIF组的(126.7±35.4)ml;住院时间为7.00(6.25,7.75)d,少于MIS-TLIF组的10.00(9.25,11.00)d,差异均有统计学意义(P<0.05)。56例患者均获12个月以上的随访。两组患者腰痛与下肢痛VAS评分及ODI与术前比较,差异均有统计学意义(P<0.05);Endo-PTLIF组术后1周和术后1个月腰痛VAS评分分别为2.00(2.00,3.00)分和2.00(2.00,2.00)分、术后1个月ODI为25.83%±3.83%,低于MIS-TLIF组的3.00(2.25,4.00)分、2.50(2.00,3.00)分和30.09%±4.02%,差异均有统计学意义(P<0.05)。术后1个月后两组下肢痛VAS评分、术后6个月后两组腰痛VAS评分与ODI的差异均无统计学意义(P>0.05)。末次随访时Endo-PTLIF组和MIS-TLIF组的MacNab优良率分别为96%与94%,差异无统计学意义(P>0.05)。术后12个月两组患者LL、DH及DObjectiveTo compare the clinical efficacy of endoscopic posterior transforaminal lumbar interbody fusion(Endo-PTLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-segment lumbar degenerative diseases.MethodsA retrospective analysis was conducted on the clinical data of 56 patients with single-segment lumbar degenerative diseases treated at Xiuzhou District People's Hospital between September 2020 and March 2023.Patients were divided into two groups based on the surgical approach:the Endo-PTLIF group(24 cases,11 males and 13 females;mean age:56.5±8.4 years,range:43-72 years)and the MIS-TLIF group(32 cases,10 males and 22 females;mean age:54.5±10.4 years,range:37-73 years).Perioperative parameters,visual analog scale(VAS)scores for pain,Oswestry disability index(ODI),lumbar lordosis(LL),disc height(DH),and dural sac cross-sectional area(DSCA)were compared between the two groups.ResultsNo significant differences were observed between the two groups in baseline characteristics,preoperative VAS,ODI,LL,DH,or DSCA(P>0.05).However,the operative time in the Endo-PTLIF group(173.9±12.3 minutes)was significantly longer than in the MIS-TLIF group(136.5±19.5 minutes,P<0.05).Similarly,the Endo-PTLIF group required more fluoroscopy exposures(15.9±1.8)than the MIS-TLIF group(13.0±1.6,P<0.05).In contrast,intraoperative blood loss in the Endo-PTLIF group(68.9±12.9 ml)was significantly lower than in the MIS-TLIF group(126.7±35.4 ml,P<0.05).Additionally,the Endo-PTLIF group had a shorter hospital stay[7.00(6.25,7.75)days]compared to the MIS-TLIF group[10.00(9.25,11.00)days,P<0.05].At one week and one month postoperatively,the Endo-PTLIF group had significantly lower back pain VAS scores[2.00(2.00,3.00)and 2.00(2.00,2.00),respectively]and a lower ODI(25.83%±3.83%)compared to the MIS-TLIF group[3.00(2.25,4.00),2.50(2.00,3.00),and 30.09%±4.02%,respectively;P<0.05].Beyond one month postoperatively,there were no significant differences in leg pain VAS scores between the groups,

关 键 词：腰椎 电视辅助外科手术 脊柱融合术 内镜 

分 类 号：R687.3[医药卫生—骨科学]