脊柱内镜联合膨胀式椎间融合治疗腰椎不稳

Endoscopic lumbar interbody fusion by expandable cage for degenerative lumbar instability

摘要:

［目的］ 评价脊柱内镜下单纯应用膨胀式椎间笼架 （expandable cage, EC） 治疗退行性腰椎不稳的临床效果。［方法］ 2018 年 3 月—2019 年 12 月，对 108 例退行性腰椎不稳患者行手术治疗。依据术前医患沟通结果，52 例采用脊柱内镜下单纯 EC 融合，56 例采用传统开放后路腰椎体间融合 （posterior lumbar interbody fusion, PLIF）。比较两组围手术期、随访和影像资料。［结果］两组患者均顺利完成手术，无严重术后并发症。两组手术时间差异无统计学意义（P>0.05）。但 EC 组术中出血量、术后引流量及住院时间均显著优于 PLIF 组 （P<0.05）。所有患者均获随访 12 个月以上。随时间推移，两组 VAS 和 ODI 评分显著下降（P<0.05），而 JOA 评分显著增加（P<0.05）。术后 8 周，EC 组的 VAS、ODI 和 JOA 评分均显著优于 PLIF 组 （P<0.05），但是末次随访时两组 VAS、ODI 和 JOA 评分的差异均无统计学意义 （P>0.05）。影像方面，两组椎间融合时间差异无统计学意义 （P>0.05）。与术前相比，末次随访时两组局部腰椎前凸角均显著增大，相应时间点两组间局部腰椎前凸角的差异均无统计学意义（P>0.05）。［结论］ 脊柱内镜下单纯 EC 治疗退行性腰椎不稳的短期临床效果优于 PLIF 术式，且手术创伤更小。

Abstract:

[Objective] To evaluate the clinical outcomes of mere endoscopic lumbar interbody fusion by using expandable cage (EC) for degenerative lumbar spinal instability. [Methods] From March 2018 to December 2019, 108 patients with degenerative lumbar spine in- stability were surgically treated in our department. According to the consequence of preoperative doctor- patient communication, 52 pa- tients underwent spinal endoscopic EC fusion, while 56 patients received traditional open posterior lumbar interbody fusion (PLIF) . The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All patients in both groups had op- eration performed successfully without serious postoperative complications. There was no statistical difference in operation time between the two groups (P＞0.05) , however, the EC group was significantly better than the PLIF group in terms of intraoperative blood loss, postoper- ative drainage and hospital stay (P＜0.05) . As time went during the follow-up period lasted for more than 12 months, the VAS and ODI scores decreased significantly (P＜0.05) , while the JOA score increased significantly in both groups (P＜0.05) . At 8 weeks postoperatively, the EC group were significantly superior to the PLIF group in terms of VAS, ODI and JOA scores (P＜0.05) , but which became not statisti- cally significant between the two groups at the last follow-up (P＞0.05) . With respect of radiographic evaluation, there was no statistical dif- ference in the time of intervertebral fusion between the two groups (P＞0.05) . The local lumbar lordosis angle increased significantly at the last follow-up in both groups compared with that preoperatively (P＜0.05) , however, there was no a significant difference in the local lumbar lordosis angle between the two groups at any corresponding time point (P＞0.05) . [Conclusion] The endoscopic lumbar interbody fusion by EC alone does achieve better short-term clinical outcome, with less surgical trauma than the traditional PLIF.