腰椎侧隐窝狭窄症内镜治疗与微创椎体间融合的比较

Comparison of endoscopic treatment and minimally invasive interbody fusion for lumbar lateral recess stenosis

摘要:

[目的] 探讨经皮椎间孔内镜技术（PELD）与微创经椎间孔椎体间融合术（MISTLIF）治疗腰椎侧隐窝狭窄症的临床疗效比较。[方法] 通过回顾性分析62例腰椎侧隐窝狭窄症患者，将27例采用PELD治疗的分为减压组，35例MISTLIF治疗的为融合组，对比两组围术期指标、随访和影像学结果。[结果] 两组患者均手术顺利完成，未发生严重手术并发症，减压组较融合组手术用时短、切口总长度小、术中是失血量少、下地行走时间早、住院天数短，差异有统计学意义（P<0.05），术中放射暴露次数差异均无统计学意义（P>0.05）。两组随访时间均超过12个月，减压组的患者完全负重活动时间明显早于融合组[(44.6±12.6)d vs 57.7±10.0)d, P<0.05]。随着时间的推移，两组患者腰痛、腿痛VAS和ODI评分均明显下降（P<0.05）。两组间术前、术后3个月和末次随访的上述评分差异无统计学意义（P>0.05）。影像学方面，末次随访时，两组椎管面积和侧隐窝矢径均较术前明显增加（P<0.05），腰椎前凸角的变化不显著（P>0.05）。两组间术前的上述指标差异不具有统计学意义（P>0.05）。在末次随访时，减压组的椎管面积[(165.0±7.3)mm2 vs (201.5±12.9)mm2 , P<0.05]、侧隐窝矢径 [(4.1±0.4)mm vs (4.9±0.5)mm, P< 0.05]均显著小于融合组，而两组间腰椎前凸角的差异不具有统计学意义（P>0.05）。[结论] 两种微创术式临床效果相当，但相比于附加融合的MISTLIF技术，应用单纯减压的PELD技术治疗腰椎侧隐窝狭窄症恢复更快，更微创。

Abstract:

[Objective] To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) and minimally invasive transforaminal interbody fusion (MISTLIF) in the treatment of lumbar lateral recess stenosis. [Methods] 62 patients with lumbar lateral recess stenosis were retrospectively analyzed, 27 patients treated with PELD were divided into decompression group and 35 patients treated with MISTLIF were divided into fusion group. Perioperative indexes, follow-up and imaging results of the two groups were compared. [Results] Compared with the fusion group, the decompression group had shorter operation time, smaller total incision length, less intraoperative blood loss, earlier walking time and shorter hospitalization days, the differences were statistically significant (P<0.05), while the intraoperative radiation exposure times were not statistically significant (P>0.05). The follow-up time of both groups was more than 12 months, and the time of full weight-bearing activity in the decompression group was significantly earlier than that in the fusion group [(44.6±12.6)d vs 57.7±10.0)d, P<0.05]. With the passage of time, lower back pain, leg pain VAS and ODI scores were significantly decreased in both groups (P<0.05). There was no significant difference in the above scores between the two groups before surgery, 3 months after surgery and the last follow-up (P>0.05). In terms of imaging, at the last follow-up, the vertebral canal area and lateral recess diameter were significantly increased in both groups (P<0.05), while the lumbar lordotic Angle was not significantly changed (P>0.05). There was no significant difference in the above indexes between the two groups before surgery (P>0.05). At the last follow-up, the spinal canal area [(165.0±7.3)mm2 vs (201.5±12.9)mm2, P<0.05] and the lateral recess diameter [(4.1±0.4)mm vs (4.9±0.5)mm, P<0.05] in the decompression group were significantly smaller than those in the fusion group. There was no significant difference in lumbar lordosis Angle between the two groups (P>0.05). [Conclusion] The clinical results of the two minimally invasive procedures are comparable, but compared with the MISTLIF technique with fusion, PELD technique with simple decompression is more rapid and less invasive in the treatment of lumbar lateral recess stenosis.