内镜与小切口经椎间孔腰椎间融合翻修术比较△（开放获取）

(Open Access) Comparisonofendoscopicversussmall-incisiontransforaminal lumbarinterbodyfusionrevisions

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.