腰椎滑脱症镜下与开放经椎间孔融合术比较△

Endoscopy- assisted versus open transforaminal lumbar interbody fusion for lumbar spondylolisthesis

摘要:

［目的］比较经皮内镜辅助和传统开放经椎间孔腰椎减压融合术 （transforaminal lumbar interbody fusion, TLIF） 治疗的腰椎滑脱症的临床效果。［方法］ 回顾性分析 2019 年 7 月—2021 年 6 月本院采用 TLIF 术治疗 64 例单节段中度腰椎滑脱症患者的临床资料。依据术前医患沟通结果，32 例采用内镜辅助下 TLIF，32 例采用传统开放 TLIF。比较两组围手术期、随访和影像资料。［结果］内镜组手术时间、切口总长度、术中失血量、术后住院时间均显著优于开放组（P<0.05），但是内镜组术中透视次数显著多于开放组（P<0.05）。术后并发症内镜组早期并发症为 1/32（3.1%），开放组为 8/32（25.0%），两组间差异有统计学意义（P=0.031）。64 例患者均获随访 12 个月以上，随时间推移，两组 ODI 评分显著下降（P<0.05），而 JOA 评分显著增加（P< 0.05）。术前两组间 ODI 和 JOA 评分的差异均无统计学意义（P>0.05），而术后 6 个月和术后 12 个月时，内镜组的 ODI 评分和 JOA 评分均显著优于开放组（P<0.05）。影像方面，与术前相比，术后两组患者的滑脱角和滑脱率均显著减少（P<0.05）。相应时间点，两组间滑脱角和滑脱率的差异均无统计学意义（P>0.05）。至末次随访时，两组均达到椎间融合，内固定物无松动。［结论］内镜辅助下 TLIF 治疗单节段轻中度腰椎滑脱症，可减少手术创伤，改进临床治疗效果。

Abstract:

[Objective] To compare the clinical outcomes of percutaneous endoscopic-assisted transforaminal lumbar interbody fusion (TLIF) versus traditional open counterpart for single-segment lumbar spondylolisthesis. [Methods] A retrospective study was performed on 64 patients who received TLIF for single-level moderate lumbar spondylolisthesis in our hospital from July 2019 to June 2021. According to preoperative doctor-patient communication, 32 cases received endoscope-assisted TLIF (the endoscopic group) , while the other 32 cases re- ceived traditional open TLIF (the open group) . The perioperative period, follow-up and imaging data were compared between the two groups. [Results] The endoscopic group proved significantly superior to the open group in terms of operation time, total incision length, intraoperative blood loss and postoperative hospital stay (P＜0.05) , despite of the fact that the endoscopic group took significantly more frequency of intraop- erative fluoroscopy than the open group (P＜0.05) . Postoperative early complications were 1/32 (3.1%) in the endoscopic group, while 8/32 (25.0%) in the open group, which was statistically significant (P=0.031) . All the 64 patients were followed up for more than 12 months. The ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups over time (P＜0.05) . Although there were no significant differences in ODI and JOA scores between the two groups before operation (P＜0.05) , the endoscopic group was significantly su- perior to the open group in the ODI and JOA scores at 6 months and 12 months after operation (P＜0.05) . Radiographically, the slippage angle and slippage rate measured on X-ray films significantly reduced in both groups postoperatively compared with those preoperatively (P＜0.05) , which were not significantly different between the two groups at any corresponding time points (P＞0.05) . At the latest follow-up, all patients in both groups got solid intervertebral fusion without loosening of internal fixators. [Conclusion] This percutaneous endoscope- assisted TLIF does reduce surgical trauma and improve clinical outcomes in the treatment of single-level mild-to-moderate lumbar spondylolisthesis.