圆柱形可膨胀融合器在内镜下腰椎间融合中的应用研究

Application of cylindrical expandable fusion cage in endoscopic lumbar interbody fusion

摘要:

目的：介绍圆柱形可膨胀融合器在内镜经椎间孔和经椎板间入路腰椎间融合中应用（Endoscopic-Transforaminal Lumbar Interbody Fusion and Endoscopic-Interlaminar Lumbar Interbody Fusion, E-TLIF and E-ILIF）的技术要点和临床影像学随访结果。 方法：2018年8月至2019年4月在我院就诊的符合纳入标准的病人，接受E-TLIF 或 E-ILIF，术中应用圆柱形可膨胀融合器，根据手术方式，分为E-TLIF 和E-ILIF组，并进行回顾性观察研究。记录切口长度、手术时间和手术相关并发症等。术前、术后6月和末次随访分别评估腰痛及腿痛的视觉模拟评分（visual analogue scale, VAS）和Oswestry残疾指数（Oswestry disability index, ODI）。术后第2天复查腰椎MRI评估神经减压情况，术后6月、1年复查腰椎X线和CT评估椎体间融合情况，观察有无融合器下沉和内固定松动，并测量椎间隙高度和腰椎前凸角（L1～L5 Cobb角）。末次随访评估MacNab评分。 结果：共32例病人纳入本研究，14人接受E-TLIF，18人接受E-ILIF。所有手术均顺利完成，无神经根损失和硬脊膜撕裂，切口均获甲级愈合。两组在切口长度、手术时间、下地行走时间和住院时间方面无统计学差异（P>0.05）。术后腰椎MRI显示所有病人神经减压充分。术后腰痛VAS、腿痛VAS、ODI评分较术前均明显改善（P<0.01）。两组病人未观察到内固定松动，腰椎融合率、融合器下沉、椎间隙高度和Cobb角无统计学差异（P>0.05）。末次随访MacNab评分，总体优良率96.9%，两组之间无统计学差异（P>0.05）。 结论：圆柱形可膨胀融合器可安全应用于E-TLIF 和 E-ILIF，两者在临床和影像学随访方面无统计学差异。

Abstract:

Objective: To introduce the technical notes of endoscopic-transforaminal lumbar interbody fusion and endoscopic-interlaminar lumbar interbody fusion with cylindrical expandable fusion cage, and the outcomes of clinical and imaging follow-up. Methods: From August 2018 to April 2019, patients who met the inclusion criteria in our hospital received Endoscopic-Transforaminal Lumbar Interbody Fusion（E-TLIF）and Endoscopic-Interlaminar Lumbar Interbody Fusion（E-ILIF）, and were divided into E-TLIF and E-ILIF groups according to the surgical method, and a retrospective observational study was performed. Incision length, operation time，surgery-related complications and so on were recorded. Visual analogue scale (VAS) of low back pain and leg pain, and Oswestry disability index (ODI) were evaluated before surgery, 6 months after surgery and at the last follow-up. Lumbar MRI was reviewed on the second day after surgery to evaluate nerve decompression. Lumbar X-ray and CT were reviewed 6 months and 1 year after surgery to evaluate interbody fusion, to observe the subsidence of fusion cage and internal fixation loosening, and to measure the disc height and lumbar lordotic Angle（L1～L5 Cobb Angle）. MacNab score was evaluated at the last follow-up. Results: A total of 32 patients were included in this study, 14 received E-TLIF and 18 received E-ILIF. All operations were successfully completed without nerve root injury and dural tear, and all incisions were Grade a healing. There were no significant differences in incision length, operation time, walking time and hospital stay between the two groups (P＞0.05). Postoperative lumbar MRI revealed sufficient nerve decompression in all patients. Postoperative VAS of low back pain and leg pain, and ODI scores were significantly improved compared with those before operation (P＜0.01). No loosening of internal fixation was observed between the two groups, and there were no significant differences in lumbar fusion rate, subsidence of cage, disc height, and L1～L5 Cobb Angle (P＞0.05). At the last follow-up, the MacNab score showed that the excellent and good rate was 96.9% between the two groups, and there was no significant difference between the two groups (P＞0.05). Conclusion: Cylindrical expandable fusion cage can be safely used in E-TLIF and E-ILIF, and there is no statistical difference in clinical and imaging follow-up between the two groups.