腰椎滑脱内镜与通道经椎间孔椎体间融合比较

Endoscopic lumbar fusion versus counterpart with tubular retractors for lumbar spondylolisthesis

摘要:

[目的] 比较单侧双通道脊柱内镜下腰椎椎间融合术（unilateral biportal endoscopy lumbar interbody fusion, UBE-LIF）与微创经椎间孔入路腰椎椎间融合术（minimally invasive surgery transforaminal lumbar interbody fusion, MIS-TLIF） 治疗II~III 度腰椎滑脱症的效果。[方法] 2019 年1 月—2022 年6 月本院收治因II~III 度腰椎滑脱症接受手术治疗的249 例患者，按随机数字表法将患者分两组，132 例采用UBE-LIF（UBE 组），另外117 采用MIS-TLIF（MIS 组），比较两组围手术期、随访及影像资料。[结果] 两组病例均顺利完成手术，未发生严重并发症。UBE 组术中失血量[(112.2±20.5) ml vs (132.9±25.8) ml, P＜0.001]、术中透视次数[(3.9±1.3) 次vs (4.6±1.5) 次, P＜0.001]、下地行走时间[(1.6±0.5) d vs (1.9±0.3) d, P＜0.001] 均显著优于MIS 组。随访时间平均（15.0±3.0） 个月，UBE 组恢复完全负重活动时间[(65.5±10.2) d vs (68.9±11.6) d, P=0.015] 显著早于MIS 组。随术后时间推移，两组VAS、ODI、JOA 评分均显著改善（P＜0.05），术后3 个月，UBE 组VAS [(2.4±0.4) vs (2.7±0.6), P＜0.001]、ODI [(29.2±6.7) vs (33.8±5.8), P＜0.001]、JOA 评分[(20.3±3.7) vs (18.6±4.2), P＜0.001] 均显著优于MIS 组。影像方面，末次随访时两组滑脱程度、椎间隙高度、LL、局部Cobb 角均显著改善（P＜0.05），相应时间点，两组上述影像指标的差异均无统计学意义（P＞0.05）。[结论] II~III 度腰椎滑脱症采用UBE-LIF 与MIS-TLIF 治疗效果相似，但UBE-LIF 在减少手术创伤及改善近期腰椎功能方面优势明显。

Abstract:

[Objective] To compare the clinical outcomes of unilateral biportal endoscopy lumbar interbody fusion (UBE-LIF), versusminimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) for degree II~III lumbar spondylolisthesis. [Methods] FromJanuary 2019 to June 2022, a total of 249 patients who received surgical treatment for degree II~III spondylolisthesis were included in thisstudy, and were divided into two groups according to random number table method. Of them, 132 patients received UBE-LIF (the UBEgroup), while other 117 received MIS-TLIF (the MIS group). The perioperative, follow-up and imaging data of the two groups were com-pared. [Results] The operation was successfully completed in both groups without serious complications. The UBE group proved significant-ly superior to the MIS group in terms of intraoperative blood loss [(112.2±20.5) ml vs (132.9±25.8) ml, P＜0.001], intraoperative fluoroscopytimes [(3.9±1.3) time vs (4.6±1.5) times, P＜0.001] and walking time after operation [(1.6±0.5) days vs (1.9±0.3) days, P＜0.001]. The averagefollow-up time was of (15.0±3.0) months, and the UBE cohort resumed full weight-bearing activity significantly earlier than the MIS [(65.5±10.2) days vs (68.9±11.6) days, P=0.015]. The VAS, ODI and JOA scores in both groups were significantly improved with the time after sur-gery (P＜0.05). The UBE group was significantly better than the MIS group in terms of VAS [(2.4±0.4) vs (2.7±0.6), P＜0.001], ODI [(29.2±6.7) vs (33.8±5.8), P＜0.001], JOA score [(20.3±3.7) vs (18.6±4.2), P＜0.001] 3 months after surgery. Radiographically, the extent of slippage,intervertebral height, lumbar lordosis, and local Cobb angle significantly improved in both groups at the last follow-up compared with thosepreoperatively (P＜0.05), whereas which was not statistically significant between the two groups at any time points accordingly (P＞0.05).[Conclusion] UBE-LIF achieves clinical consequence similar to MIS-TLIF for degree II~III lumbar spondylolisthesis. However, the UBELIFhas obvious advantages in reducing surgical trauma and improving short-term lumbar function over the MIS-TLIF.