精准内镜与微创减压融合治疗多节段腰椎管狭窄症△

Precise endoscopic decompression and instrumented fusion versus small-incision counterpart for multi-segmental lumbarspinal stenosis

摘要:

[目的] 比较单侧双通道内镜下经椎间孔腰椎间融合术（unilateral biportal endoscopy transforaminal lumbar interbody fu-sion, UBE-TLIF） 和微创经椎间孔腰椎间融合（minimal invasive transforaminal lumbar interbody fusion, MIS-TLIF） 治疗腰椎管狭窄症（lumbar spinal stenosis, LSS） 的临床效果。[方法] 回顾性分析2022 年1 月—2023 年8 月本院基于神经阻滞定位的微创手术治疗多节段腰椎管狭窄症52 例患者的临床资料。依据术前医患沟通结果，28 例采用UBE-TLIF 治疗；24 例采用MIS-TLIF 治疗。比较两组患者围手术期、随访和影像资料。[结果]两组均顺利完成手术，无死亡及神经损伤等严重并发症发生。UBE-TLIF 组在手术时间[(137.7±24.6) min vs (154.8±34.5) min, P=0.042]、术中出血量[(182.5±33.2) ml vs (211.7±57.4) ml, P=0.027]、下床时间[(2.4±0.5) d vs (3.3±0.4) d, P＜0.001]、住院时间[(7.3±1.4) d vs (8.4±2.1) d, P=0.042] 均显著优于MIS-TLIF 组。所有患者随访（10.6±1.9）个月，随时间推移，两组的VAS 评分、ODI 和JOA 评分均显著改善（P＜0.05）；相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，术后两组硬膜囊面积、责任节段椎间隙高度较术前均显著改善（P＜0.05）；但相应时间点，两组间影像指标的差异均无统计学意义（P＞0.05）。末次随访时，UBE-TLIF 组融合率为89.3%， MIS-TLIF 组为91.7%，差异无统计学意义（P＞0.05）。[结论] 精准模式微创减压固定融合治疗多节段腰椎管狭窄症，可显著减少手术创伤和患者经济负担。两种术式均可取得满意临床疗效，相比之下，UBE-TLIF 组在手术时间、术中出血量、下床时间、住院时间优于MIS-TLIF 组。

Abstract:

[Objective] To compare clinical consequences of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) for multi-segment lumbar spinal stenosis (LSS).[Methods] A retrospective analysis was performed on 52 patients who received accurate minimal invasive surgery based on nerve block loca-tion for multi-level LSS in our hospitals from January 2022 to August 2023. According to preoperative doctor-patient communication, 28 pa-tients were treated with UBE-TLIF, while other 24 patients underwent MIS-TLIF. The perioperative, follow-up and imaging data of the twogroups were compared. [Results] All patients in both groups had operation performed successfully without serious complications, such asdeath and nerve injury. The UBE-TLIF group proved significantly superior to the MIS-TLIF group in terms of operative time [(137.7±24.6)min vs (154.8±34.5) min, P=0.042], intraoperative blood loss [(182.5±33.2) ml vs (211.7±57.4) ml, P=0.027], bed rest time [(2.4±0.5) days vs(3.3±0.4) days, P＜0.001], hospital stay [(7.3±1.4) days vs (8.4±2.1) days, P=0.042]. As time went on during follow-up period lasted for (10.6±1.9) months in a mean, the VAS, ODI and JOA scores in both groups were significantly improved (P＜0.05), whereas which were not statisti-cally significant between the two groups at any corresponding time points (P＞0.05). As for imaging, the area of internal dural sac and height of intervertebral space at the responsible level were significantly improved in both groups after surgery (P＜0.05), while which were not signifi-cantly different between the two groups at any time points accordingly (P＞0.05). At the last follow-up, the intervertebral fusion rate was of89.3% in the UBE-TLIF group, while 91.7% in the MIS-TLIF group, and the difference was not statistically significant (P＞0.05). [Conclu-sion] The accurate minimally invasive decompression and instrumented fusion in the treatment of multi-level lumbar spinal stenosis do sig-nificantly reduce surgical trauma and patients’ economic burden. In contrast, UBE-TLIF group was superior to MIS-TLIF group in terms ofoperation time, intraoperative blood loss, bed rest and hospital stay.