骨质疏松腰椎滑脱的单侧双通道内镜腰椎间融合

Unilateral biportal endoscopic lumbar interbody fusion for osteoporotic lumbar spondylolisthesis

摘要:

[目的] 评价单侧双通道内镜下经椎间孔腰椎间融合术 （unilateral biportal endoscopic transforaminal lumbar interbody fusion, UBE-TLIF） 辅以骨水泥强化螺钉治疗骨质疏松腰椎滑脱症的临床疗效。[方法] 2022 年 8 月—2023 年 8 月本院应用上述技术治疗的 40 例骨质疏松Ⅰ、Ⅱ度腰椎滑脱症患者纳入本研究，评价临床及辅助检查结果。[结果]所有患者均顺利完成手术，手术时间平均（170.3±14.6）min，术中出血量平均（123.6±10.8）mL，住院时间平均（13.8±1.3）d。与术前相比，术后 6 个月及末次随访时，患者腰痛 VAS [(7.6±0.7), (1.8±0.4), (1.6±0.5), P＜0.001]、腿痛 VAS [(8.1±0.6), (1.3±0.5), (1.2±0.4), P＜0.001] 及 ODI 评分 [(58.8±5.3), (33.3±5.1), (30.1±7.2), P＜0.001] 均显著降低。与术前相比，术后 1 d Hb 水平显著下降 （P＜0.05），而 CRP、 ESR、CPK 水平均显著升高（P＜0.05），但术后 3 d 各指标均恢复至正常水平。影像方面，与术前相比，术后 6 个月及末次随访时，滑脱率 [(16.7±3.4)%, (5.1±1.5)%, (4.2±1.6)%, P＜0.001]、椎管面积 [(71.4±8.3) cm2 , (115.3±6.8) cm2 , (112.6±8.4) cm2 , P＜0.001]、 腰椎前凸角 [(52.8±6.3)°, (49.2±2.8)°, (46.2±4.9 )°, P＜0.001]、侧隐窝矢状径 [(1.8±0.4) mm, (3.6±0.5) mm, (3.4±0.3) mm, P＜0.001] 及椎间隙高度 [(7.4±1.6) mm, (11.4±1.2) mm, (10.6±1.7) mm, P＜0.001] 均显著改善，术后随时间推移，融合评级 [例, I/II/III/IV (34/5/1/ 0) , (37/3/0/0), P＜0.001] 显著改善。[结论]UBE-TLIF 辅以骨水泥强化螺钉能有效复位滑脱，实现椎管减压，且融合率高，近期疗效满意。

Abstract:

[Objective] To evaluate the clinical consequence of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) with augmented pedicle screw for osteoporotic lumbar spondylolisthesis. [Methods] From August 2022 to August 2023, 40 patients received the abovesaid surgical treatment for osteoporosis grade I and II lumbar spondylolisthesis. The clinical and auxiliary examination documents were evaluated. [Results] All the patients were operated on smoothly, with the average operation time of (170.3±14.6) min, the average intraoperative blood loss of (123.6±10.8) mL, and the average hospital stay of (13.8±1.3) days. With time preoperatively, 6 months after surgery and at the last follow-up, the low back pain VAS [(7.6±0.7), (1.8±0.4), (1.6±0.5), P＜0.001], leg pain VAS [(8.1±0.6), (1.3±0.5), (1.2±0.4), P＜0.001] and ODI scores [(58.8±5.3), (33.3±5.1), (30.1±7.2), P＜0.001] were significantly decreased. In term of blood test, the Hb significantly decreased 1 day after surgery (P＜0.05), while CRP, ESR and CPK significantly increased (P＜0.05), whereas which all returned to normal level 3 days after surgery. In term of imaging, with time preoperatively, 6 months after surgery and at the last followup, the slippage ratio [(16.7±3.4)%, (5.1±1.5)%, (4.2±1.6)%, P＜0.001], spinal canal area [(71.4±8.3) cm2 , (115.3±6.8) cm2 , (112.6±8.4) cm2 , P＜0.001], lumbar lordotic angle [(52.8±6.3), (49.2±2.8), (46.2±4.9), P＜0.001], sagittal diameter of lateral recess [(1.8±0.4) mm, (3.6± 0.5) mm, (3.4±0.3) mm, P＜0.001] and intervertebral height [(7.4±1.6) mm, (11.4±1.2) mm, (10.6±1.7) mm, P＜0.001] significantly improved. In addition, the fusion scale [I/II/III/IV, (34/5/1/0), (37/3/0/0), P＜0.001] improved significantly at the latest followup compared with that 6 months postoperatively. [Conclusion] UBE-TLIF combined with augmented pedicle screw does effectively reduce spondylolisthesis and achieve spinal canal decompression, and get high fusion rate and satisfactory short-term clinical outcome