两种微创融合术治疗腰退行性疾病比较

Comparison of two minimally invasive fusion procedures for lumbar degenerative diseases

摘要:

[目的] 比较内镜椎间盘切除辅助斜外侧椎间融合术 （endoscopic discectomy-assisted oblique lumbar interbody fusion, ED-OLIF） 与微创经椎间孔入路腰椎椎间融合术 （minimally invasive transforaminal lumbar interbody fusion, Mis-TLIF） 治疗腰退行性疾病的临床效果。[方法]回顾性分析 2016 年 8 月—2020 年 6 月微创手术治疗腰退行性疾病 51 例患者的临床资料，依据医患沟通结果，26 例采用 ED-OLIF，另外 25 例采用 Mis-TLIF。比较两组围手术期、随访以及影像资料[结果]虽然 ED-OLIF 组手术时间显著长于 Mis-TLIF 组 [(281.8±79.7) min vs (182.2±42.3) min, P＜0.05]，但是前者在切口长度 [(5.7±0.2) cm vs (7.0±1.2) cm , P＜0.05]、术中出血量 [(107.3±44.2) ml vs [(196.0±80.3) ml, P＜0.05] 以及下地行走时间 [(3.1±1.2) d vs (6.4±1.6) d, P＜0.05] 均显著优于后者。所有患者平均随访（29.8±11.3）个月，ED-OLIF 组恢复完全负重活动时间显著早于 Mis-TLIF 组 [(28.7±4.1) d vs (46.0± 5.3) d, P＜0.05]。随着时间的推移，两组患者 JOA 评分显著增加（P＜0.05），VAS、ODI 评分显著降低（P＜0.05）。术前两组间上述指标的差异均无统计学意义 （P＞0.05），出院时 ED-OLIF 组 VAS 评分 [(3.0±0.7) vs (3.9±0.9), P＜0.05]、JOA 评分 [(20.6±4.5) vs (16.6±2.0), P＜0.05]、ODI 评分 [(33.4±12.6) vs (35.2±3.7), P＜0.05] 显著优于 Mis-TLIF 组，末次随访时两组上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比末次随访时两组椎间隙高度均显著增加（P＜0.05）。相应时间点两组椎间隙高度、腰椎前凸角和 Bridwell 融合等级的差异无统计学意义（P＞0.05）。[结论]对于腰退行性疾病的患者，ED-OLIF 较 Mis-TLIF 手术创伤更小，术后疼痛缓解以及功能恢复更快。

Abstract:

[Objective] To compare the clinical outcomes of endoscopic discectomy-assisted oblique interbody fusion (ED-OLIF) ver- sus minimally invasive transforaminal interbody fusion (Mis-TLIF) for the treatment of lumbar degenerative diseases. [Methods] A retro- spective study was conducted on 51 patients who received the minimally invasive surgical treatments for lumbar degenerative diseases from August 2016 to June 2020. According to doctor-patient communication, 26 patients received ED-OLIF, while the other 25 patients received Mis-TLIF. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] Although ED-OLIF group con- sumed significantly longer operation time than the Mis-TLIF group [(281.8±79.7) min vs (182.2±42.3) min, P＜0.05], the former proved sig- nificantly superior to the latter in terms of incision length [(5.7±0.2) cm vs (7.0±1.2) cm, P＜0.05], intraoperative blood loss [(107.3±44.2) ml vs [(196.0±80.3) ml, P＜0.05] and postoperative walking time [(3.1±1.2) days vs (6.4±1.6) days, P＜0.05]. All patients were followed up for a mean of (29.8±11.3) months, and the ED-OLIF group resumed full weight-bearing activity significantly earlier than the Mis-TLIF group [(28.7±4.1) days vs (46.0±5.3) days, P＜0.05]. The JOA scores significantly increased (P＜0.05), while VAS and ODI scores significantly de- creased in both groups over time (P＜0.05). There was no statistical significance in the above indexes between the two groups before surgery (P＞0.05). The ED-OLIF group was significantly superior to the Mis-TLIF group in terms of VAS score [(3.0±0.7) vs (3.9±0.9), P＜0.05], JOA score [(20.6±4.5) vs (16.6±2.0), P＜0.05], ODI score [(33.4±12.6) vs (35.2±3.7), P＜0.05] at discharge, whereas which became not statistically significant between the two groups at the last follow-up (P＞0.05). Regarding imaging, the height of intervertebral space was significantly in- creased in both groups at the last follow-up compared with those preoperatively (P＜0.05), but there were no significant differences in inter- vertebral height, lumbar lordosis angle and Bridwell fusion grade between the two groups at any corresponding time points (P＞0.05). [Con- clusion] Compared with Mis-TLIF, the ED-OLIF is less invasive, and achieves faster postoperative pain relief and functional recovery for lumbar degenerative diseases.