单侧双通道脊柱内镜与PLIF治疗腰椎邻椎病的比较

Comparison of unilateral biportal endoscopic and PLIF treatment of adjacent segment disease

摘要:

【摘要】目的:比较单侧双通道脊柱内镜(unilateral biportal endoscopic, UBE)与后路腰椎间融合术（posterior lumbar interbody fusion,PLIF）治疗腰椎邻椎病的临床疗效。方法: 2021年01月-2022年9月对57例腰椎融合术后邻椎病患者行手术治疗，依据术前医患沟通结果，31例行UBE手术治疗，26例行PLIF手术治疗，比较两组患者的围术期及相关随访资料。结果:两组患者均顺利完成手术，两组各1例发生神经根外膜撕裂，出现术后下肢一过性疼痛，给予激素、脱水等对症治疗。给予去枕平卧、延长置管时间及局部加压缝合治疗后顺利恢复。UBE组在手术时间[(84.1±11.5)min vs (149.2±11.4)min, P<0.05]、切口总长度[(2.3±0.4)cm vs (12.3±1.5)cm, P<0.05]、术中失血量[(27.9±4.0)ml vs (266.5±16.0)ml, P<0.05]、术中透视次数[(3.1±0.5)次 vs (5.4±0.5)次, P<0.05]、下地时间[(2.5±0.5)d vs (3.6±0.6)d P<0.05]、住院时间[(5.4±0.6)d vs (9.6±0.6)d, P<0.05]、完全负重活动时间[(49.7±3.3)d vs (60.2±1.1)d, P<0.05]均显著优于PLIF组。两组患者的腰、腿痛VAS及ODI评分较术前明显改善(P<0.05)。两组患者的椎管面积及侧隐窝矢径较术前均显著增加(P<0.05)，两组腰椎前凸角无显著变化(P>0.05)。末次随访时，UBE组的椎管面积[(160.3±6.6)mm2 vs (179.9±1.8)mm2, P<0.05]、侧隐窝矢径[(3.9±.01)mm vs (4.2±0.1)mm, P<0.05]均显著小于PLIF组(P<0.05)，术前两组之间同时间的上述指标比较差异均无统计学意义(P>0.05)。结论: 单侧双通道脊柱内镜治疗腰椎邻椎病，安全可行，创伤小，不破坏腰椎后方张力带结构，恢复快，临床效果好。

Abstract:

Abstract: [Objective] To explore the clinical effect of unilateral biportal endoscopic (UBE) and posterior lumbar interbody fusion (PLIF) in the treatment of adjacent segment disease. Methods: From January 2021 to September 2022, 57 patients with adjacent segment disease were treated after lumbar fusion surgery. According to the results of preoperative doctor-patient communication, 31 cases were treated with UBE surgery and 26 cases were treated with PLIF. The perioperative period and related follow-up data of the two groups of patients were compared. Results: Both groups of patients successfully completed the operation. One case in each of the two groups suffered a tear of the nerve root epidural, and the postoperative pain in the lower limbs occurred. Hormones, dehydration and other symptomatic treatment were given. Smooth recovery after removing pillow and lying flat, extending the tube placement time and local pressurised suture treatment. UBE group in operation time [(84.1±11.5)min vs (149.2±11.4min, P<0.05], total incision length [(2.3±0.4)cm vs (12.3±1.5)cm, P<0.05], intraoperative blood loss Amount [(27.9±4.0)ml vs (266.5±16.0)ml, P<0.05], intraoperative fluoroscopy times [(3.1±0.5) times vs (5.4±0.5) times, P<0.05], time to go down to the ground [(2.5±0.5)d v S (3.6±0.6)d P<0.05], hospitalisation time [(5.4±0.6)d vs (9.6±0.6)d, P<0.05], full load activity time [(49.7±3.3)d vs (60.2±1.1)d, P<0 .05] All of them are significantly better than the PLIF group. The VAS and ODI scores of low back and leg pain in the two groups were significantly improved compared with preoperative (P<0.05). The area of the spinal canal and the vector diameter of the lateral crypt in the two groups of patients increased significantly compared with preoperative (P<0.05), and there was no significant change in the anterior convex angle of the lumbar vertebra in the two groups (P>0.05). During the last follow-up, the spinal area of the UBE group [(160.3±6.6)mm2 vs (179.9±1.8)mm2, P<0.05], lateral crypt arrow diameter [(3.9±.01)mm vs (4.2±0.1)mm, P<0.05]. It is significantly smaller than the PLIF group (P<0.05), and the comparison difference between the above indicators between the two groups before surgery is not statistically significant (P>0.05). Conclusion: Unilateral double-channel spinal endoscopy for the treatment of adjacent segment disease is safe and feasible, with little trauma, no destruction of the posterior tension band structure of the lumbar spine, fast recovery and good clinical effect.