腰椎退行性病双通道内镜与开放椎间融合比较△

Biportal endoscopic lumbar interbody fusion versus open counterpart for lumbar degenerative diseases

摘要:

[目的] 比较双通道脊柱内镜下椎间融合术 （biportal endoscopic lumbar interbody fusion, BE-LIF） 与传统半椎板切除腰椎椎间融合术 （hemilamiectomy and lumbar interbody fusion, HL-LIF） 治疗腰椎退行性疾病的临床疗效。[方法] 回顾性分析 2022 年 3 月—2022 年 11 月在本院手术治疗的腰椎退行性疾病 78 例患者的临床资料。按照医患沟通结果，35 例采用 BELIF，41 例采用 HL-LIF。比较两组围手术期、随访及辅助检查等资料。[结果] 虽然 BE-LIF 组手术时间显著长于 HL-LIF 组，但 BE-LIF 组切口长度 [(7.1±1.0) cm vs (11.5±2.2) cm, P＜0.001]、术中失血量 [(240.0±121.2) ml vs (344.9±140.9) ml, P＜0.001]、 下地时间 [(3.2±0.5) d vs (4.4±0.5) d, P＜0.001] 均显著优于 HL-LIF 组。平均随访时间 （15.8±2.3） 个月，随时间推移，两组的 VAS、ODI、JOA 评分均显著改善 （P＜0.05）。术后 5 个月时，BE-LIF 组的腰痛 VAS [(1.4±0.5) vs (1.8±0.7), P=0.005]、ODI [(15.3±2.5) vs (16.7±3.2), P=0.039]、JOA 评分 [(25.3±1.0) vs (24.2±1.5), P＜0.001] 均显著优于 HL-LIF 组。影像方面，两组术后椎间隙高度、腰椎前凸角度均较术前显著增加 （P＜0.05）。各时间点两组椎间隙高度、腰椎前凸角、椎间融合 Bridwell 等级的差异无统计学意义 （P＞0.05）。[结论] 两种术式均取得良好的临床疗效。BE-LIF 较 HL-LIF 手术创伤小，术后早期腰部疼痛轻， 功能恢复速度快。

Abstract:

[Objective] To compare clinical efficacy of biportal endoscopic lumbar interbody fusion (BE-LIF) versus conventional hemilamiectomy lumbar interbody fusion (HL-LIF) for degenerative lumbar diseases. [Methods] A retrospective study was done on 78 patients who received surgical treatment for lumbar degenerative diseases in our hospital from March 2022 to November 2022. According to the results of doctor-patient discussion, 35 patients received BE-LIF, while other 41 patients underwent HL-LIF. The perioperative period, follow-up and auxiliary examination were compared between the two groups. [Results] Although the BE-LIF cohort consumed significantly longer operative time than the HL-LIF cohort, the former proved significantly superior to the latter in terms of incision length [(7.1±1.0) cm vs (11.5±2.2) cm, P＜0.001], intraoperative blood loss [(240.0±121.2) ml vs (344.9±140.9) ml, P＜0.001], postoperative walking time [(3.2±0.5) days vs (4.4±0.5) days, P＜0.001]. With time of the follow-up lasted for (15.8±2.3) months in a mean, the VAS, ODI and JOA scores in both groups significantly improved (P＜0.05). The BE-LIF group was significantly better than the HL-LIF group in terms of low back pain VAS [(1.4±0.5) vs (1.8± 0.7), P=0.005], ODI [(15.3±2.5) vs (16.7±3.2), P=0.039] and JOA score [(25.3±1.0) vs (24.2±1.5), P＜0.001] 5 months after surgery. As for imaging, the intervertebral space height and the lumbar lordosis were significantly increased in both groups after surgery (P＜0.05). However, there were no significant differences in intervertebral space height, lumbar lordosis and intervertebral fusion Bridwell grade between the two groups at any time points accordingly (P＞0.05). [Conclusion] Both of the lumbar fusion methods achieved good clinical outcomes. By comparison, the BE-LIF takes advantage of minimally invasive surgery, with less pain in early stage after operation and faster function recovery over the HL-LIF.