内镜下全可视技术减压融合治疗腰椎滑脱临床疗效  

Clinical outcomes of the treatment of lumbar spondylolisthesis with fully visual spinal endoscopic intervertebral fusion

作　　者：苗胜 殷国勇[2] 徐龙 韩培峰 冯艳涛 江永亮 陈聪 张耀 MIAO Sheng;YIN Guoyong;XU Long;HAN Peifeng;FENG Yantao;JIANG Yongliang;CHEN Cong;ZHANG Yao(Department of Orthopaedics,The Affiliated Suqian First People′s Hospital of Nanjing Medical University,Suqian 223800;Department of Orthopaedics,Jiangsu Provincial People's Hospital,Nanjing 210000;Department of Orthopaedics,Pizhou East Great Hospital,Pizhou 221300)

机构地区：[1]南京医科大学附属宿迁第一人民医院骨科,宿迁223800 [2]江苏省人民医院骨科,南京210000 [3]邳州东大医院骨科,邳州221300

出　　处：《颈腰痛杂志》2025年第1期8-13,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察脊柱内镜下全可视腰椎管减压椎间融合(Endo-PLIF)治疗腰椎滑脱症的临床效果。方法回顾性分析2019年3月至2021年10月在宿迁市第一人民医院脊柱外科手术治疗腰椎滑脱症患者79例临床资料,分为两组:微创组(A组)37例,行全可视脊柱内镜下椎间融合技术;开放组(B组)42例,行经典后路腰椎椎体间融合术(PLIF)。观察围手术期两组术中出血量、手术时间、术后下床时间、术后出院时间及并发症等;分析术后1周、术后1个月及末次随访时两组视觉疼痛评分(VAS)、功能障碍指数(ODI)及改良MacNab评价标准评估两组患者的临床疗效;比较两组手术前后腰椎滑脱率、椎间隙高度,评价滑脱复位情况。结果A组出血量、术后下床时间、术后出院时间均少于B组(P<0.05);其中A组术后并发椎管内血肿形成1例,B组发生1例术中硬膜撕裂脑脊液漏,余均无严重并发症出现;A组术后1周及术后1个月的VAS评分均低于B组,差异有统计学意义(P<0.05);A组术后1周及术后1个月ODI均优于B组,差异有统计学意义(P<0.05);但末次随访时,两组间上述评分差异无统计学意义(P>0.05);术后末次随访两组患者腰椎滑脱率较术前均减少(P<0.05),椎间隙高度较术前均增加(P<0.05),但组间差异无统计学意义(P>0.05);末次随访时按照改良MacNab疗效评估结果:A组优良率91.83%;B组优良率88.17%;两组优良率比较差异无统计学意义(P>0.05)。结论脊柱内镜下腰椎管减压椎间融合技术(Endo-PLIF)治疗腰椎滑脱症临床疗效确切,术后早期可获得更好的疗效,且具有创伤更小、出血少、恢复更快等优点。Objective To evaluate the clinical outcomes of fully visual spinal endoscopic intervertebral fusion(Endo-PLIF)for lumbar spondylolisthesis.Methods A retrospective analysis of the clinical data of 79 patients with lumbar spondylolisthesis who fully visual spinal Endo-PLIF and posterior lumbar interbody fusion(PLIF)in the Department of Spine Surgery of The First People's Hospital of Suqian City from March 2019 to October 2021 were divided into two groups:37 cases in the endoscopy group(group A)underwent percutaneous full-view spinal endoscopy;42 cases in the PLIF group(group B)underwent PLIF.The blood loss,operating time,the leaving bed time,hospital stay,postoperative complications were compared between the groups.And the visual pain score(VAS),Oswestry disability index(ODI)at 1 week,1 month and the latest follow-up after surgery and the modified MacNab criteria at the latest follow-up were compared to evaluate the clinical efficacy of the two groups of patients.The lumbar spondylolisthesis rate and intervertebral height before and after surgery were compared between the two groups to evaluate the reduction of spondylolisthesis.Results All surgical procedures were successfully performed,among them,one postoperative intraspinal hematoma was formed in group A,and one intraoperative dural tear cerebrospinal fluid leakage occurred in group B,with all remaining without serious complications;The volume of bleeding,the leaving bed time and hospital stay in group A was lower than that of group B,with a statistically significant difference(P<0.05);The VAS scores at 1 week and 1 month after surgery were lower than group B,with a statistically significant difference(P<0.05);ODI index group A postoperative 1week and 1 month better than group B,statistically significant(P<0.05);However,at the latest follow-up,there was no significant difference between the two groups(P>0.05);The lumbar spondylolisthesis rate at the latest follow-up in the two groups was reduced compared with that pre-operation(P<0.05);And the intervertebral he

关 键 词：脊柱微创 全可视技术 脊柱内镜 腰椎滑脱 镜下融合 滑脱复位 

分 类 号：R681.53[医药卫生—骨科学]