椎管狭窄合并腰椎失稳与滑脱的MED内镜辅助融合△

Microendoscopic discectomy system assisted minimally invasive transforaminal lumbar interbody fusion for spinal stenosis accompanied with lumbar instability versus spondylolisthesis

摘要:

［目的］ 比较显微内镜椎间盘切除系统 （microendoscopic discectomy, MED） 辅助下微创经椎间孔腰椎体间融合术 （minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF） 治疗椎管狭窄合并腰椎失稳与滑脱的临床效果。［方法］ 回顾性分析 2005 年 5 月—2018 年 5 月，本院应用内镜 mis-TLIF 治疗椎管狭窄 935 例患者的临床资料。依据术前影像诊断，462 例伴腰椎失稳，另外 473 例伴腰椎滑脱。比较两组围手术期、随访及影像学结果。［结果］两组均顺利完成手术，无严重并发症。两组在手术时间、切口总长度、术中失血量、术后引流量、下地行走时间、切口愈合等级及住院时间的差异均无统计学意义（P>0.05）。随时间推移，两组患者的 VAS 和 ODI 评分均显著下降（P<0.05）。术后 1 个月时失稳组的 VAS 和 ODI 评分显著优于滑脱组（P<0.05），但是，术后 6、12、48 个月两组上述指标的差异已无统计学意义（P>0.05）。影像方面，两组间椎弓钉置入的准确性的 Gertzbein -Robbins 评级差异无统计学意义 （P>0.05）。与术后 6 个月相比，术后 48 个月两组 BSF 融合评级显著改善（P<0.05）；相应时间点两组间 BSF 融合评级的差异均无统计学意义（P>0.05）。［结论］内镜 mis-TLIF 治疗椎管狭窄合并腰椎失稳或腰椎滑脱均可取得满意的临床效果，具有视野清晰，操作准确的优点。

Abstract:

[Objective] To compare the clinical outcomes of microendoscopic discectomy system (MED) assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for spinal canal stenosis accompanied with lumbar instability (LI) versus lumbar spon- dylolisthesis (LS) . [Methods] From May 2005 to May 2018, a total of 935 patients received MED assisted MIS-TLIF for spinal canal steno- sis in our hospital. According to preoperative radiographs, 462 patients were diagnosed of LI accompanied, while the remaining 473 pa- tients had LS. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups were operated on successfully without serious complications. There were no significant differences between the two groups in terms of operative time, total incision length, intraoperative blood loss, postoperative drainage, walking time, incision healing and hospital stay (P＞ 0.05) . The VAS and ODI scores decreased significantly over time in both groups (P＜0.05) , which in the LI group were significantly better than those in the LS group at 1 and 6 months postoperatively (P＜0.05) , but became not significantly different between the two groups at 12 and 48 months after surgery (P＞0.05) . Radiographically, there was no significant difference in term of Gertzbein-Robbins scales for the ac- curacy of pedicle placement between the two groups (P＞0.05) . Compared with that 6 months postoperatively, BSF fusion classification sig- nificantly upgraded in both groups at 48 months after surgery (P＜0.05) , however, there were no statistically significant differences in BSF classification between the two groups at the any corresponding time points (P＞0.05) . [Conclusion] The MED assisted MIS- TLIF does achieve satisfactory clinical outcomes for spinal stenosis accompanied with both lumbar instability and lumbar spondylolisthesis, and has the advantages of accurate operation under clear vision.