轻中度腰椎滑脱症UBE-TLIF与MIS-TLIF对比

UBE-TLIF versus MIS-TLIF for mild to moderate lumbar spondylolisthesis

摘要:

[目的] 比较单侧双通道内镜经椎间孔腰椎椎体间融合（unilateral biportal endoscopy transforaminal lumbar interbody fu-sion, UBE-TLIF） 与微创经椎间孔腰椎椎体间融合术（minimal invasive transforaminal lumbar interbody fusion, MIS-TLIF） 治疗轻中度腰椎滑脱症（LS） 的疗效。[方法] 回顾性收集2022 年1 月—2023 年3 月收治的106 例LS 患者临床资料，依据术前医患沟通结果，50 例采用UBE-TLIF，另外56 例采用MIS-TLIF。对比两组围手术期、随访及影像指标。[结果] UBE-TLIF 组手术时间显著长于MIS-TLIF 组[(145.0±31.2) min vs (124.8±20.5) min, P＜0.001]，但是UBE-TLIF 组在切口总长度[(3.4±0.5) cm vs (6.2±0.8) cm, P＜0.001]、术中失血量[(113.54±30.8) ml vs (125.3±22.6) ml, P=0.026]、术中透视次数[(5.0±1.7)次vs (7.0±2.5)次, P＜0.001]、下地行走时间[(1.8±0.7.2) d vs (3±0.6) d, P＜0.001] 与住院时间[(6.2±1.8) d vs (7.5±2.6) d, P=0.004] 均显著优于MIS-TLIF 组。随访时间（16.5±3.1） 个月，随时间推移，两组腰痛和腿痛VAS 以及ODI 评分均显著降低（P＜0.05），而JOA 评分显著增加（P＜0.05）。UBE-TLIF 组术后1 周腰痛VAS 评分[(3.4±0.9) vs (4.0±1.0), P=0.002] 显著优于MIS-TLIF 组。影像方面，与术前相比，术后两组椎间盘高度（disc height, DH）、腰椎前凸角（lumbar lordosis, LL）、椎间孔面积（foraminal area, A）、椎体滑脱率均显著改善（P＜0.05）；UBE-TLIF 组术后1 周DH [(11.8±2.0) mm vs (11.0±1.8) mm, P=0.033]、FA [(13.4±2.0) mm2 vs (12.5±2.1) mm2, P=0.026] 均显著大于MIS-TLIF 组。[结论] UBE-TLIF 治疗单节段轻中度LS 可取得与MIS-TLIF 类似的效果，但UBE-TLIF 相对切口更小、出血量更少、术后早期恢复更快。

Abstract:

[Objective] To compare the clinical consequence of unilateral biportal endoscopy transforaminal lumbar interbody fusion(UBE-TLIF) versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) for mild to moderate lumbar spondylolisthesis(LS). [Methods] A retrospective study was done on106 patients who had LS treated surgically in our hospital from January 2022 to March2023. According to preoperative doctor-patient communication, 50 patients received UBE-TLIF, while other 56 patients underwent MISTLIF.The documents regarding perioperative period, follow-up and images of the two groups were compared. [Results] Although the UBETLIFgroup consumed significantly longer operation time than the MIS-TLIF group [(145.0±31.2) min vs (124.8±20.5) min, P＜0.001], the for-mer proved significantly superior to the latter in terms of the total incision length [(3.4±0.5) cm vs (6.2±0.8) cm, P＜0.001], intraoperativeblood loss [(113.54±30.8) ml vs (125.3±22.6) ml, P=0.026], intraoperative fluoroscopy times [(5.0±1.7) times vs (7.0±2.5) times, P＜0.001],walking time [(1.8±0.7) days vs (2.3±0.6) days, P＜0.001] and hospital stay [(6.2±1.8) days vs (7.5±2.6) days, P=0.004]. With time of the fol-low-up lasted for (16.5±3.1) months in a mean, the VAS scores for back pain and leg pain, as well as ODI scores were significantly decreased(P＜0.05), while JOA scores were significantly increased in both groups (P＜0.05). The UBE-TLIF group proved significantly better than theMIS-TLIF group in back pain VAS score [(3.4±0.9) vs (4.0±1.0), P=0.002] 1 week after surgery. With respect of imaging, compared withthose preoperatively, the disc height (DH), lumbar lordosis (LL), foraminal area (FA), and vertebral spondylolisthesis percentage were signifi-cantly improved in both groups after surgery (P＜0.05). The UBE-TLIF group had significantly greater DH [(11.8±2.0) mm vs (11.0±1.8) mm,P=0.033] and FA [(13.4±2.0) mm2 vs (12.5±2.1) mm2, P=0.026] than the MIS-TLIF group one week after surgery. [Conclusion] UBE-TLIFachieve similar outcomes to MIS-TLIF in the treatment of single-segment mild to moderate LS, but UBE-TLIF has advantages of smaller in-cisions, less bleeding and faster early postoperative recovery over the MIS-TLIF.