内镜减压与开放延长PLIF治疗腰椎融合后邻椎病△

Endoscopic decompression versus open extension of posterior lumbar interbody fusion for adjacent segment diseases second⁃ ary to lumbar fusion

摘要:

[目的]比较后路内镜减压与开放延长后路腰椎椎间融合术（posterior lumbar interbody fusion, PLIF）治疗腰椎融合术后邻椎病的临床疗效。[方法]回顾性分析 2017 年 1 月—2020 年 1 月本院收治的邻椎病 26 例患者的临床资料，依据医患沟通结果，12 例采用后路内镜减压 （内镜组），14 例采用开放延长 PLIF （PLIF 组）。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术，术中均无严重并发症。内镜组在手术时间 [(61.1±20.4)min vs (124.2±27.9)min , P＜0.05]、切口总长度 [(0.7±0.1)cm vs (10.7±1.6)cm , P＜0.05]、术中失血量 [(8.8±7.1)ml vs (244.4±108.4)ml, P＜0.05]、下地时间 [(1.6±0.7)d vs (3.7±1.5)d , P＜0.05]、住院时间 [(5.6±1.9)d vs (9.5±2.5)d , P＜0.05] 均显著优于 PLIF 组。两组患者均获 12 个月以上随访，内镜组恢复完全负重活动显著早于 PLIF 组 [(56.7±5.4)d vs (67.3±6.8)d, P＜0.05]。随时间推移，两组腰痛 VAS、腿痛 VAS、ODI 和 JOA 评分均显著改善 （P＜0.05）。相应时间点，两组患者上述指标的差异均无统计学意义（P＞0.05）。影像方面，末次随访时，两组椎管面积、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）。术前两组之间的上述指标比较差异均无统计学意义（P＞ 0.05），末次随访时，内镜组的椎管面积 [(142.2±14.7)mm² vs (182.0±20.5)mm² , P＜0.05]、侧隐窝矢径 [(3.4±0.4)mm vs (4.3±0.7)mm, P＜ 0.05] 均显著小于 PLIF 组（P＜0.05），两组腰椎前凸角的差异无统计学意义（P＞0.05）。[结论] 本研究中后路内镜减压治疗邻椎病具有创伤小、恢复快等优势，可取得与开放延长 PLIF 相当的治疗效果。

Abstract:

[Objective] To compare the clinical efficacy of posterior endoscopic decompression versus open extension of the posterior in- terbody fusion (PLIF) for adjacent segment disease secondary to lumbar fusion. [Methods] A retrospective study was done on 26 patients who received surgical treatment for the adjacent segment disease in our hospital from January 2017 to January 2020. According to the doctorpatient communication, 12 patients received posterior endoscopic decompression (endoscopic group) and 14 patients received open prolonga- tion of PLIF (PLIF group). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had the corresponding surgical procedures performed successfully without serious complications during the operation. The endo- scopic group proved significantly superior to the PLIF group in terms of operation time [(61.1±20.4)min vs (124.2±27.9)min, P＜0.05], total in- cision length [(0.7±0.1)cm vs (10.7±1.6)cm, P＜0.05], intraoperative blood loss [(8.8±7.1)ml vs (244.4±108.4)ml, P＜0.05], ambulation time [(1.6±0.7)days vs (3.7±1.5)days, P＜0.05] and hospital stay [(5.6±1.9)days vs (9.5±2.5)days, P＜0.05] . All patients in both groups were fol- lowed up for more than 12 months, and the endoscopy group returned to full weight- bearing activities significantly earlier than the PLIF group [(56.7±5.4)days vs (67.3±6.8)days, P＜0.05] . The VASs both for back pain and leg pain, ODI and JOA scores improved significantly over time in both groups (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding imaging, the spinal canal area and the sagittal diameter of the lateral recess significantly increased (P＜0.05), whereas the lumbar lordosis angle remained unchanged in both groups at the latest follow-up compared with those preoperatively (P＞0.05). Although there was no significant difference in the abovementioned indexes between the two groups before surgery (P＞0.05), the endoscopic group had signifi- cantly less the spinal canal area [(142.2±14.7)mm² vs (182.0±20.5)mm² , P＜0.05] and lateral recess diameter [(3.4±0.4)mm vs (4.3±0.7)mm, P＜0.05] than the PLIF group at the latest follow-up, whereas without a significant difference in lumbar lordosis angle between the two groups (P＞0.05). [Conclusion] In this study, posterior endoscopic decompression for adjacent segment disease has the advantages of less trauma and faster recovery, and dose achieve the same clinical outcomes as open extension of PLIF.