首页 > 过刊浏览>2024年第32卷第23期 >2113-2119. DOI:10.20184/j.cnki.Issn1005-8478.100834
PDF
内镜与小切口经椎间孔腰椎间融合翻修术比较△（开放获取）
作者:
作者单位:

1.广西中医药大学，广西南宁 530200 ;2.广西中医药大学第一附属医院，广西南宁 530003 ;3.横州市中医医院 ,广西南宁 530399

作者简介:

蒙觉威，硕士研究生，研究方向：脊柱、脊髓相关疾病研究，（电子信箱）958839371@qq.com

中图分类号:

R687

基金项目:

广西中医药适宜技术开发与推广项目（编号：GZSY23-28）；广西中医药大学校级课题项目（编号：2022MS043）


(Open Access) Comparisonofendoscopicversussmall-incisiontransforaminal lumbarinterbodyfusionrevisions
Author:
Affiliation:

1.GuangxiUniversityofTraditionalChineseMedicine,Nanning 530200 ,Guangxi,China ;2.TheFirstAffiliatedHospital,GuangxiUniversityofTradition⁃ alChineseMedicine,Nanning 530003 ,Guangxi,China ;3.HengzhouHospitalofTraditionalChineseMedicine,Nanning 530399 ,Guangxi, China

  • 摘要
    • | |
  • 访问统计
    • |
  • 参考文献 [25]
    • |
  • 相似文献
    • | | |
  • 文章评论
    摘要:

    [目的]比较内镜下经椎间孔入路腰椎椎间融合术（endoscopictransforaminallumbarinterbodyfusion,Endo-TLIF）与微创经椎间孔腰椎椎体间融合术（minimallyinvasivetransforaminal lumbarinterbodyfusion,MIS-TLIF）单节段腰椎翻修术的疗效。[方法]回顾性分析2016年10月—2022年1月在本院脊柱外科接受单节段腰椎翻修手术60例患者的临床资料，根据医患沟通结果，30例采用行Endo-TLIF术翻修（内镜组），30例采用MIS-TLIF术翻修（小切口组），比较两组围手术期、随访及影像学资料。[结果]内镜组手术时间[(163.0±11.4)minvs(187.8±10.9)min,P＜0.001]、切口总长度[(6.0±0.2)cmvs(7.2±0.8) cm,P＜0.001]、术中出血量[(88.3±10.5)mlvs(110.2±11.7)ml,P＜0.001]、术中透视次数[6.0±1.5)次vs(8.0±1.3)次,P＜0.001]、下地行走时间[(3.1±1.8)dvs(5.7±2.1)d,P＜0.001]、住院天数[(4.9±1.5)dvs(7.9±2.6)d,P＜0.001]均显著优于小切口组。两组术中并发症发生率的差异无统计学意义（P＞0.05）。两组患者均获12个月以上随访，内镜组恢复完全负重活动时间显著早于小切口组 [(28.2±3.9)dvs(35.7±6.5)d,P＜0.001]。随时间推移，两组腰痛、腿痛VAS和ODI评分均显著减少（P＜0.05）。术后3个月，内镜组腰痛VAS[(2.9±1.3)vs(4.1±1.7),P=0.006]、腿痛VAS[(2.4±1.2)vs(3.2±1.3),P=0.026]和ODI评分[(10.7±3.1)vs(14.1±5.1),P= 0.003]均显著优于小切口组。影像方面，术后两组椎管面积、椎间隙高度明显增加（P＜0.05），相应时间点，两组间上述影像指标及融合分级的差异均无统计学意义（P＞0.05）。[结论]对于单节段腰椎翻修，Endo-TLIF能获得与MIS-TLIF具有相同的治疗效果，并且，Endo-TLIF创伤更小、并发症更少、术后恢复更快、安全性更高。

    Abstract:

    [Objective]Tocomparetheclinicaloutcomesofendoscopictransforaminal lumbar interbodyfusion(Endo-TLIF)versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-segment lumbar revision. [Methods]Aretrospective studywasconductedon60patientswhounderwent single-level lumbar revisionsurgeryinthespinal surgerydepartmentofourhospital fromOctober2016toJanuary2022.Accordingtodoctor-patientcommunication,30patientsunderwentEndo-TLIFrevision,whereasother 30patientsunderwentMIS-TLIFrevision.Theperioperativeperiod, follow-upandimagingdataof thetwogroupswerecompared. [Results]Theendo-TLIFgroupprovedsignificantlysuperior totheMIS-TLIFgroupintermsofoperationtime[(163.0±11.4)minvs (187.8± 10.9)min,P＜0.001], total incisionlength[(6.0±0.2) cmvs (7.2±0.8) cm,P＜0.001],bloodloss [(88.3±10.5)ml vs (110.2±11.7)ml,P＜ 0.001],intraoperativefluoroscopytimes[(6.0±1.5)timesvs(8.0±1.3)times,P＜0.001],ambulationtime[(3.1±1.8)daysvs(5.7±2.1)days,P＜ 0.001],hospitalizationdays[(4.9±1.5)daysvs(7.9±2.6)days,P＜0.001],however, therewasnosignificantdifferenceintheincidenceof intraoperativecomplicationsbetweenthetwogroups(P＞0.05).Patientsinbothgroupswerefollowedupformorethan12months,andthosein theEndo-TLIFgroupregainedfullweight-bearingactivitiessignificantlyearlier thanthat intheMIS-TLIFgroup[(28.2±3.9)daysvs (35.7±6.5)days,P＜0.001].TheVASsbothforlowerbackpainandlegpain,aswellasODIsignificantlydecreasedinbothgroupsovertime (P＜0.05).TheEndo-TLIFwassignificantlybetter thantheMIS-TLIFintermslowbackpainVAS[(2.9±1.3)vs (4.1±1.7),P=0.006], leg pain VAS [(2.4±1.2) vs (3.2±1.3), P=0.026] and ODI scores [(10.7±3.1) vs (14.1±5.1), P=0.003] 3 months postoperatively. As for imaging, the vertebral canal area and intervertebral space height were significantly increased in both groups after surgery compared with those preoperatively (P＜0.05), whereas there were not statistically significant differences in the above imaging indexes and fusion grades between the two groups at corresponding time points (P＞0.05). [Conclusion] Endo-TLIF can achieve the same therapeutic effect as MIS-TLIF for single-level lumbar revision. By comparison, the Endo-TLIF has less trauma, fewer complications, faster postoperative recovery and higher safety over the MIS-TLIF.

    参考文献
    [1] 王海波,孙卫平.通道减压单侧非融合固定治疗腰椎间盘突出症[J].中国矫形外科杂志,2022,30(21):2010-2013.DOI:10.3977/j.issn.1005-8478.2022.21.20 Wang HB,Sun WP.Decompression and unilateral non-fusion pedicle screw fixation by the Quadrant channel for lumbar disc herniation [J].Orthopedic Journal of China,2022,30(21):2010-2013.DOI:10.3977/j.issn.1005-8478.2022.21.20.
    [2] 刘涛,俞兴,关健斌,等.多节段腰椎退行性疾病非融合与融合固定比较[J].中国矫形外科杂志,2023,31(13):1164-1170.DOI:10.3977/j.issn.1005-8478.2023.13.03.Liu T,Yu X,Guan JB,et al.Comparison of non-fusion versus fusion pedicle screw fixation for multilevel lumbar degenerative disease [J].Orthopedic Journal of China,2023,31(13):1164-1170.DOI:10.3977/j.issn.1005-8478.2023.13.03.
    [3] 林顺,刘锦涛,姜宏,等.内镜椎间盘切除术后残留症状原因与处理 [J].中国矫形外科杂志,2024,32(1):61-66.DOI:10.3977/j.issn.1005-8478.2024.01.10.Lin S,Liu JT,Jiang H,et al.Reason and management of residual symptoms after endoscopic discectomy [J].Orthopedic Journal of China,2024,32(1):61-66.DOI:10.3977/j.issn.1005-8478.2024.01.10.
    [4] 刘洋,马彬,李玉乔,等.腰椎椎间融合术后神经并发症的相关因素[J].中国矫形外科杂志,2023,31(8):673-677.DOI:10.3977/j.issn.1005-8478.2023.08.01.Liu Y,Ma B,Li YQ,et al.Factors related to postoperative neurological complications in lumbar interbody fusion [J].Orthopedic Journal of China,2023,31(8):673-677.DOI:10.3977/j.issn.100 5-8478.2023.08.01.
    [5] YagiK,Kishima K,Tezuka F,et al.Advantages of revision transfo?raminal full-endoscopic spine surgery in patients who have previously undergone posterior spine surgery [J].J Neurol Surg A Cent Eur Neurosurg,2023,84(6):528-535.DOI:10.1055/a-1877 0594.
    [6] Park MK,Park SA,Son SK,et al.Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion(ULIF)compared with conventional posterior lumbar interbody fusion(PLIF):1-year follow-up [J].Neurosurg Rev,2019,42(3):753-761.DOI:10.1007/s10143-019-01114-3.
    [7] AoS,ZhengW,WuJ,etal.Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital:Is percutaneous endoscopic procedure superior to MIS-TLIF?A prospective cohort study [J].Int J Surg,2020,76:136-143.DOI:10.1016/j.ijsu.2020.02.043.
    [8] Kolcun JPG,Brusko GD,Wang MY.Endoscopic transforaminal lumbar interbody fusion without general anesthesia:technical innovations and outcomes [J].Ann Transl Med,2019,7(Suppl 5):S167.DOI:10.21037/atm.2019.07.92.
    [9] 陈勇喜,覃海飚,钟远鸣,等.自研新型器械经皮腰椎融合术治疗腰椎滑脱[J].中国矫形外科杂志,2022,30(15):1410-1413.DOI:10.3977/j.issn.1005-8478.2022.15.14.Chen YX,Qin HB,Zhong YM,et al.Percutaneous lumbar interbody fusion with novel self-developed instruments for lumbar spondylolisthesis [J].Orthopedic Journal of China,2022,30(15):1410-1413.DOI:10.3977/j.issn.1005-8478.2022.15.14.
    [10] Bridwell KH,Lenke LG,Mcenery KW,et al.Anterior fresh frozen structural allografts in the thoracic and lumbar spine.Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defect [J].Spine(Phila Pa 1976),1995,20(12):1410-1418.
    [11] 毛克亚,王岩,肖嵩华,等.微创与开放经椎间孔腰椎椎体间融合翻修术的临床疗效比较[J].中国脊柱脊髓杂志,2013,23(9):789-793.DOI:10.3969/j.issn.1004-406X.2013.09.05.Mao KY,Wang Y,Xiao SH,et al.Clinical outcomes of minimally invasive versus open transforaminal lumbar interbody fusion for lumbar revision surgery [J].Chinese Journal of Spine and Spinal Cord,2013,23(9):789-793.DOI:10.3969/j.issn.1004-406X.201 3.09.05.
    [12] Wang A,Yu Z.Comparison of percutaneous endoscopic lumbar discectomy with minimally invasive transforaminal lumbar interbody fusion as a revision surgery for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy [J].Ther Clin Risk Manag,2020,16:1185-1193.DOI:10.2147/TCRM.S28 3652.
    [13] Gatam aR,Gatam L,Mahadhipta H,et al.Unilateral biportal endoscopic lumbar interbody fusion:a technical note and an outcome comparison with the conventional minimally invasive fusion [J].Orthop Res Rev,2021,13:229-239.DOI:10.2147/ORR.S336479.
    [14] Marie-Hardy L,Wolff S,Frison-Roche A,et al.Minimal invasive management of early revision after minimal invasive posterior lumbar fusion [J].Orthop Traumatol Surg Res,2020,106(6):1209 1214.DOI:10.1016/j.otsr.2020.04.003.
    [15] Shih CM,Hsu CE,Chen KH,et al.Surgical outcomes of anterior lumbar interbody fusion in revision lumbar interbody fusion surgery [J].J Orthop Surg Res,2023,18(1):497.DOI:10.1186/s130 18-023-03972-6.
    [16] Miscusi M,Trungu S,Ricciardi L,et al.Stand-alone oblique lumbar interbody fusion(OLIF)for the treatment of adjacent segment disease(ASD)after previous posterior lumbar fusion:clinical and radiological outcomes and comparison with posterior revision surgery [J].J Clin Med,2023,12(8):2985.DOI:10.3390/jcm12082 985.
    [17] Liu G,Liu W,Jin D,et al.Clinical outcomes of unilateral biportal endoscopic lumbar interbody fusion(ULIF)compared with conventional posterior lumbar interbody fusion(PLIF)[J].Spine J,2023,23(2):271-280.DOI:10.1016/j.spinee.2022.10.001.
    [18] Brusko GD,Wang MY.Endoscopic lumbar interbody fusion [J].Neurosurg Clin N Am,2020,31(1):17-24.
    [19] Kang MS,Heo DH,Kim HB,et al.Biportal endoscopic technique for transforaminal lumbar interbody fusion:review of current research [J].Int J Spine Surg,2021,15(suppl 3):S84-s92.DOI:10.14444/8167.
    [20] Ruetten S,Komp M,Merk H,et al.Recurrent lumbar disc herniation after conventional discectomy:a prospective,randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision [J].J Spinal Disord Tech,2009,22(2):122-129.DOI:10.1097/BSD.0b013e318175ddb4.
    [21] Xiao C,Yin W,Zhao K,et al.Early clinical efficacy of Endo-TLIF in the treatment of lumbar disc herniation [J].Z Orthop Unfall,2022,160(6):670-678.DOI:10.1055/a-1795-4038.
    [22] Guo H,Song Y,Weng R,et al.Comparison of clinical outcomes and complications between endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases:a systematic review and Meta-analysis [J].Global Spine J,2023,13(5):1394-1404.DOI:10.1177/21925682221142545.
    [23] LiW,WeiH,Zhang R.Different lumbar fusion techniques for lumbar spinal stenosis:a Bayesian network meta-analysis [J].BMC Surg,2023,23(1):345.DOI:10.1186/s12893-023-02242-w.
    [24] Ge M,Zhang Y,Ying H,et al.Comparison of hidden blood loss and clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion [J].Int Orthop,2022,46(9):2063-2070.DOI:10.1007/s00264-022-05485-z.
    [25] 张斌,孔清泉,戎利民.经皮内镜辅助腰椎椎间融合术的技术利弊分析及趋势展望[J].中国修复重建外科杂志,2022,36(6):653-659.DOI:10.7507/1002-1892.202202075.Zhang B,Kong QQ,Rong LM.Analysis of technical advantages and disadvantages of percutaneous endoscopic lumbar interbody fusion and its trend prospect [J].Chinese Journal of Reparative and Reconstructive Surgery,2022,36(6):653-659.DOI:10.7507/100 2-1892.202202075.
    相似文献
    引证文献
引用本文

蒙觉威,陈勇喜,覃海飚,等. 内镜与小切口经椎间孔腰椎间融合翻修术比较△（开放获取）[J]. 中国矫形外科杂志, 2024, 32 (23): 2113-2119. DOI：10.20184/j. cnki. Issn1005-8478.100834.
MENGJue-wei, CHEN Yong-xi, QINHai-biao, et al. (Open Access) Comparisonofendoscopicversussmall-incisiontransforaminal lumbarinterbodyfusionrevisions[J]. Orthopedic Journal of China , 2024, 32 (23): 2113-2119. DOI：10.20184/j. cnki. Issn1005-8478.100834.

复制
文章指标
  • 点击次数:
  • 下载次数:
  • 引用次数:
历史
  • 收稿日期:2023-11-15
  • 最后修改日期:2024-05-24
  • 在线发布日期: 2024-12-04
请使用 Firefox、Chrome、IE10、IE11、360极速模式、搜狗极速模式、QQ极速模式等浏览器，其他浏览器不建议使用!
通讯地址：山东省泰安市泰山区环山路217-1号泰安八十八医院 中国矫形外科杂志编辑部 邮政编码：271000 电话：0538-6213228
网址：https://jxwk.ijournals.cn/ E-mail：jiaoxingtougao@163.com
中国矫形外科杂志 ® 2025 版权所有