低度腰椎滑脱症经皮内镜与切开腰椎间融合比较（开放获取）

Percutaneous endoscopic lumbar fusion versus open counterpart for low grade lumbar spondylolisthesis (OA)

摘要:

[目的]比较分析经皮大通道脊柱内镜（percutaneous endoscopic lumbar interbody fusion, PELIF）与切开后路腰椎间融合术 （posterior lumbar interbody fusion, PLIF） 治疗单节段低度腰椎滑脱症的临床疗效。[方法] 回顾性分析 2020 年 1 月—2023 年 2 月本院手术治疗的 56 例单节段低度腰椎滑脱症患者的临床资料。根据术前医患沟通结果，27 例接受 PELIF；另外 29 例接受 PLIF 治疗。比较两组围手术期资料、随访结果和影像学资料。[结果]PELIF 组切口总长度 [(8.3±1.5) cm vs (10.2±2.2) cm, P＜ 0.001]、术中失血量 [(151.9±99.5) ml vs (303.5±117.2) ml, P＜0.001]、开始下地行走时间 [(2.2±0.9) d vs (3.3±0.9) d, P＜0.001]、住院时间 [(5.9±1.8) d vs (8.6±2.3) d, P＜0.001] 均显著优于 PLIF 组，PELIF 组手术时间 [(178.3±32.5) min vs (134.5±27.4) min, P＜0.001] 和术中透视次数 [(34.3±7.1) 次 vs (12.0±4.0) 次, P＜0.001] 显著大于 PLIF 组；两组术中并发症率和切口愈合等级的差异无统计学意义 （P＞0.05）。56 例平均随访时间 （16.3±2.6） 个月。随时间推移，两组腰痛 VAS 评分、腿痛 VAS 评分、ODI、JOA 评分均显著改善（P＜0.05）。术后第 3 d PELIF 组的腰 VAS 评分显著低于 PLIF 组 [(2.6±1.9) vs (4.0±1.8), P=0.005]，但是，相应时间点两组腿痛 VAS 评分、ODI、JOA 评分组间比较差异无统计学意义 （P＞0.05）。影像方面，术后两组腰椎前凸角、椎间隙高度、滑脱率、椎管面积均较术前显著改善 （P＜0.05），相应时间点，两组组间比较差异无统计学意义 （P＞0.05）。[结论] 采用 PELIF 与开放 PLIF 治疗低度腰椎滑脱症都可以取得令人满意的疗效，但 PELIF 具有创伤小、术后早期腰痛缓解快优点。

Abstract:

[Objective] To compare the clinical efficacy of percutaneous endoscopic lumbar interbody fusion with large channel (PE-LIF) versus open posterior lumbar interbody fusion (PLIF) for single-level and low-grade lumbar spondylolisthesis. [Methods] A retrospective study was conducted on 56 patients who received lumbar fusion for the single-level and low-grade lumbar spondylolisthesis in our hospital from January 2020 to February 2023. According to preoperative dock-patient communication, 27 patients underwent PELIF, while other 29 patients received PLIF. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The PELIF group proved significantly superior to the PLIF group in terms of total incision length [(8.3±1.5) cm vs (10.2±2.2) cm, P＜0.001], intraoperative blood loss [(151.9±99.5) ml vs (303.5±117.2) ml, P＜0.001], time to return walking [(2.2±0.9) days vs (3.3±0.9) days, P＜0.001], hospitalization [5.9±1.8) days vs (8.6±2.3) days, P＜0.001], despite of the fact that the former was significantly inferior to the latter in terms of operative time [(178.3±32.5) min vs (134.5±27.4) min, P＜0.001] and intraoperative fluoroscopy times [(34.3±7.1) times vs (12.0±4.0) times, P＜ 0.001]. There was no significant difference in intraoperative complication rate and incision healing grade between the two groups (P＞0.05). As time went on during follow-up period lasted for (16.3±2.6) months, VAS score for leg pain, VAS score for back pain, ODI score and JOA score significantly improved in both groups (P＜0.05). The PELIF group had significantly lower lumbago VAS score than the PLIF group 3 days postoperatively [(2.6±1.9) vs (4.0±1.8), P=0.005], whereas there were no significant differences in the leg pain VAS score, ODI and JOA scores between the two groups at any time points accordingly (P＞0.05). As for imaging, the lumbar lordosis angle, intervertebral space height, slipping rate and spinal canal area significantly improved in both groups after surgery compared with those preoperatively (P＜0.05), while which were not statistically different between the two groups at any corresponding time points (P＞0.05). [Conclusion] Both PELIF and open PLIF can achieve satisfactory efficacy in the treatment of low-grade lumbar spondylolisthesis, but PELIF has the advantages of less trauma and quick recovery in early stage after operation over the PLIF.