腰椎侧隐窝狭窄症内镜减压与微创椎体间融合的比较△（开放获取）

Comparison of endoscopic decompression and minimally invasive interbody fusion for lumbar lateral recess stenosis (Open Access)

摘要:

[目的]比较经皮椎间孔内镜技术（percutaneous endoscopic lumbar discectomy, PELD）与微创经椎间孔椎体间融合术 （minimally invasive transforaminal lumbar interbody fusion, MISTLIF） 治疗腰椎侧隐窝狭窄症的临床疗效。[方法] 回顾性分析 62 例腰椎侧隐窝狭窄症患者的临床资料，根据医患沟通结果，27 例采用 PELD 治疗 （减压组），35 例采用 MISTLIF 治疗 （融合组），比较两组围术期指标、随访和影像学结果。[结果]两组患者均顺利完成手术，未发生严重手术并发症。减压组手术用时 [(54.4±11.4) min vs (104.4±10.5) min, P＜0.001]、切口总长度 [(0.9±0.1) cm vs (6.2±1.5) cm, P＜0.001]、术中失血量 [(38.5±18.8) ml vs (85.1±50.8) ml, P＜0.001]、下地行走时间 [(10.7±6.6) d vs (29.1±12.7) d, P＜0.001]、住院天数 [(6.1±1.6) d vs (8.5±2.6) d, P＜0.001] 均显著优于融合组。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显著早于融合组 [(44.6±12.6) d vs (57.7±10.0) d, P＜ 0.001]。随时间推移，两组患者腰痛、腿痛 VAS 和 ODI 评分均显著改善（P＜0.05）。相应时间点，两组间上述评分的差异无统计学意义（P＞0.05）。影像方面，与术前比较，末次随访时两组椎管面积和侧隐窝矢径均显著增加（P＜0.05），而腰椎前凸角无显著变化（P＞0.05）。术前两组上述指标的差异均无统计学意义（P＞0.05）。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＜0.001]、侧隐窝矢径 [(4.1±0.4) mm vs (4.9±0.5) mm, P＜0.001] 均显著小于融合组，两组间腰椎前凸角的差异无统计学意义（P＞0.05）。[结论]两种微创术式临床效果相当，但相比 MISTLIF 技术，应用单纯减压的 PELD 技术治疗腰椎侧隐窝狭窄症更微创，患者恢复更快。

Abstract:

[Objective] To compare the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus minimally invasive transforaminal lumbar interbody fusion (MISTLIF) for lumbar lateral recess stenosis. [Methods] A retrospective study was conducted on 62 patients who received surgical treatment for lumbar lateral recessional stenosis. According to the preoperative doctor-patient communication, 27 patients had spinal canal decompressed with PELD (the decompression group), while other 35 patients were treated with MISTLIF (the fusion group). The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious surgical complications. The decompression group proved significantly superior to the fusion group in terms of operation time [(54.4±11.4) min vs (104.4±10.5) min, P＜0.001], total incision length [(0.9±0.1) cm vs (6.2±1.5) cm, P＜0.001], intraoperative blood loss [(38.5±18.8) ml vs (85.1±50.8) ml, P＜0.001], postoperative walking time [(10.7±6.6) days vs (29.1±12.7) days, P＜0.001] and hospital stay [(6.1±1.6) days vs (8.5±2.6) days, P＜0.001]. All patients in both groups were followed up for more than 12 months, and the decompression group resumed full weight-bearing activity significantly earlier than the fusion group [(44.6±12.6) days vs (57.7±10.0) days, P＜0.001]. The VAS scores for lower back pain and leg pain, as well as ODI score significantly declined over time in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05). Radiographically, the vertebral canal area and lateral recess diameter significantly increased in both groups at the last follow-up compared with those preoperatively (P＜0.05), while the lumbar lordosis angle remained unchanged (P＞0.05). Although there was no significant difference between the two groups before operation (P>0.05), the decompression group got significantly less spinal canal area [(165.0±7.3) mm² vs (201.5±12.9) mm² , P<0.001] and the lateral recess diameter [(4.1±0.4) mm vs (4.9±0.5) mm, P<0.001] than the fusion group at the last followup, but there was no statistically significant difference in lumbar lordosis angle between the two groups (P> 0.05). [Conclusion] The clinical consequence of the two minimally invasive procedures are comparable. However, the simple decompression with PELD technique takes advantages of more minimally invasive and faster recovery in the treatment of lumbar lateral recess stenosis over the MISTLIF.