内镜与开放后路椎间融合术治疗腰椎退行疾病

Endoscopic versus open posterior lumbar interbody fusion for lumbar degenerative diseases

摘要:

[目的] 比较传统开放后路椎间融合 (posterior lumbar interbody fusion, PLIF) 内镜镜下后路椎间融合 (endoscopic posterior lumbar interbody fusion, Endo-PLIF)治疗腰椎退变性疾病的临床效果。[方法]2020 年 1 月—2021 年 6 月本科手术治疗的腰椎退变性疾病患者 40 例患者纳入本研究。依据术前医患沟通效果，20 例采用 Endo-PLIF 术，另外 20 例采用传统开放 PLIF 术。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术，术中无严重并发症。内镜组的手术时间和术中透视次数显著多于开放组(P＜0.05)，但是内镜组术中失血量、术后恢复下地时间和住院时间均显著优于开放组(P＜0.05)。两组间切口总长度、切口愈合情况的差异无统计学意义(P＞0.05)。两组患者均获随访 12 个月以上，内镜组恢复完全负重时间显著早于开放组(P＜0.05)。随时间推移，两组腰痛 VAS 评分和 ODI 评分显著下降(P＜0.05)，而 JOA 评分均显著增加(P＜0.05)；出院时、术后 6 个月、末次随访内镜组上述评分均显著优于开放组(P＜0.05)。影像方面，与术前相比，术后 6 个月和末次随访时， 两组椎间隙高度、腰椎前凸角均显著增加(P＜0.05)，相应时间点两组间的差异均无统计学意义(P＞0.05)。此外，相应时间点两组间 Bridwell 融合分级的差异无统计学意义(P＞0.05)。[结论]相较于传统开放 PLIF 术，Endo-PLIF 治疗腰椎退变性疾病疗效确切，具备创伤性低、手术出血量少、术后恢复快等优势。

Abstract:

[Objective] To compare clinical outcomes of endoscopic posterior lumbar interbody fusion (Endo-PLIF) versus traditional open posterior lumbar interbody fusion (PLIF) for lumbar degenerative diseases [Methods] From January 2020 to June 2021, a total of 40 pa- tients received PLIF for lumbar degenerative diseases in our department. According to the results of preoperative doctor-patient communica- tion, 20 patients received Endo-PLIF, while the other 20 patients received traditional open PLIF. The document regarding perioperative peri- od, follow-up and images were compared between the two groups. [Results] All patients in both groups had corresponding PLIF performed smoothly without serious complications. Although the Endo group consumed significantly longer operation time and more intraoperative fluo- roscopy times than the open group (P＜0.05) , the former proved significantly superior to the latter in terms of intraoperative blood loss, post- operative walking time and hospital stay (P＜0.05) . However, there were no significant differences in the total incision length and incision healing grade between the two groups (P＞0.05) . All patients in both groups were followed up for more than 12 months, and the Endo group re- gained full weight-bearing activity significantly earlier than the open group (P＜0.05) . The VAS score for lower back pain and ODI score de- creased significantly (P＜0.05) , while the JOA scores increased significantly over time in both groups (P＜0.05) . At discharge, 6 months after surgery and at the last follow-up the Endo group was significantly better than the open group in abovesaid scores (P＜0.05) . Radiographical- ly, intervertebral height and lumbar lordosis significantly increased 6 months after surgery and at the latest follow-up in both groups com- pared with those before surgery (P＜0.05) , whereas which were not significantly different between the two groups at any corresponding time points (P＞0.05) . In addition, there was no significant difference in Bridwell fusion grades between the two groups at the corresponding time points (P＞0.05) . [Conclusion] he Endo-PLIF is effective treatment for lumbar degenerative diseases, with advantages of less trauma, less in- traoperative bleeding and faster postoperative recovery over the traditional open PLIF