腰椎管狭窄退行性滑脱症内镜减压与椎间融合比较△

Endoscopic decompression versus posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis complicatedwith spinal stenosis

摘要:

[目的] 比较脊柱内镜下单纯减压与传统开放减压固定融合治疗腰椎管狭窄退行性滑脱症的临床疗效。[方法] 回顾性分析2021 年1 月—2022 年9 月本院手术治疗退行性腰椎滑脱椎管狭窄63 例患者的临床资料。根据医患沟通结果，26 例采用脊柱内镜下单纯减压（减压组），37 例采用开放减压融合（融合组）。比较两组围手术期资料、随访及影像结果。[结果] 减压组在手术时间[(94.6±24.2) min vs (161.1±26.1) min, P＜0.001]、术中失血量[(19.8±7.5) ml vs (155.4±57.5) ml, P＜0.001]、切口总长度[(2.0±0.2) cm vs (7.2±1.2) cm, P＜0.001]、术中透视次数[(2.7±0.7) 次vs (4.5±1.3) 次, P＜0.001]、术后引流量[(12.2±9.5) ml vs (275.9±171.8) ml, P＜0.001]、术后下地行走时间[(3.1±1.0) d vs (15.3±4.4) d, P＜0.001]、住院天数[(6.9±3.0) d vs (13.2±6.2) d, P＜0.001] 均显著优于融合组。平均随访时间（14.8±2.7） 个月，两组完全负重活动时间的差异无统计学意义（P＞0.05），随时间推移，两组VAS 评分、ODI 指数均显著减少（P＜0.05），相应时间点，两组VAS 评分、ODI 指数的差异均无统计学意义（P＞0.05）。术后第12 个月，两组改良MacNab 评分差异无统计学意义（P＞0.05）。影像方面，与术前相比，术后两组腰椎前凸角无显著变化（P＞0.05），相应时间点，两组腰椎前凸角的差异无统计学意义（P＞0.05）。[结论] 脊柱内镜下单纯减压术与传统开放减压融合术治疗退行性滑脱腰椎管狭窄的临床效果相似，但脊柱内镜下单纯减压显著减少了手术创伤和患者负担。

Abstract:

[Objective] To compare the clinical efficacy of endoscopic decompression alone versus traditional open decompression andinstrumented fusion (posterior lumbar interbody fusion, PLIF) in the treatment of degenerative lumbar spondylolisthesis with spinal stenosis.[Methods] A retrospective study was done on 63 patients who received surgical treatment for degenerative lumbar spondylolisthesis with spi-nal stenosis in our hospital from January 2021 to September 2022. According to the doctor-patient communication, 26 patients underwent en-doscopic decompression only (the decompression group), while other 37 patients underwent open PLIF (the fusion group). The perioperativedata, follow-up and imaging results were compared between the two groups. [Results] The decompression group was significantly superior tothe fusion group in terms of operative time [(94.6±24.2) min vs (161.1±26.1) min, P＜0.001], intraoperative blood loss [(19.8±7.5) ml vs(155.4±57.5) ml, P＜0.001], total length of incision [(2.0±0.2) cm vs (7.2±1.2) cm, P＜0.001], intraoperative fluoroscopy times [(2.7±0.7) timesvs (4.5±1.3) times, P＜0.001], drainage volum [(12.2±9.5) ml vs (275.9±171.8) ml, P＜0.001], postoperative ambulation [(3.1±1.0) days vs(15.3±4.4) days, P＜0.001] and hospital stay [(6.9±3.0) days vs (13.2±6.2) days, P＜0.001]. The mean follow-up time was of (14.8±2.7)months, and there was no statistical significance in the time to resume full weight-bearing activities between the two groups (P＞0.05). Astime went on, the VAS score and ODI index of the two groups were significantly decreased (P＜0.05), whereas which were not statistically sig-nificant between the two groups at any corresponding time points (P＞0.05). At 12 months after surgery, there was no significant difference inmodified MacNab grades between the two groups (P＞0.05). As for imaging, there were no significant changes in lumbar lordotic angle in bothgroups after surgery compared with that preoperatively (P＞0.05), which was not statistically significant between the two groups at correspond-ing time points (P＞0.05). [Conclusion] Endoscopic decompression alone achieve satisfactory clinical outcomes similar to those of conven-tional open decompression and instrumented fusion in the treatment of degenerative lumbar spondylolisthesis and spinal stenosis, however,