经皮Kambin三角入路腰椎融合术治疗退行性腰椎滑脱△（开放获取）

Percutaneous Kambin's triangle approach lumbar interbody fusion for degenerative lumbar spondylolisthesis

摘要:

[目的] 对比自研配套器械经皮Kambin 三角入路腰椎间融合术（percutaneous Kambin triangle approach lumbar inter-body fusion, PKLIF） 与常规微创经椎间孔腰椎间融合术（minimal invasive transforaminal lumbar interbody fusion, MIS-TLIF） 治疗退行性腰椎滑脱（degenerative lumbar spondylolisthesis, DLS） 的临床疗效。[方法] 回顾性分析2023 年3 月—2024 年3 月本院收治的32 例DLS 患者的临床资料。根据术前医患沟通结果，15 例采用自研配套器械行PKLIF，另外17 例行常规入路MISTLIF。比较两组临床及影像资料。[结果] 所有患者均顺利完成手术，无神经损伤及死亡等严重并发症，平均随访时间（6.0±1.8） 个月。PKLIF 术中出血量[(82.7±9.6) ml vs (165.3±25.3) ml, P＜0.001]、下地时间[(1.9±0.7) d vs (3.1±0.6) d, P＜0.001]、住院时间[(8.3±2.2) d vs (11.7±2.6) d, P＜0.001]、术后1 d 腰痛VAS 评分[(1.8±0.7) vs (2.9±0.7), P＜0.001]、术后2 周ODI 评分[(31.2±3.0)vs (40.6±5.8), P＜0.001] 均显著优于MIS-TLIF。但是，PKLIF 组透视次数[(17.7±1.7) 次vs (5.1±1.0) 次, P＜0.001] 及手术时间[(134.0±12.4) min vs (115.9±13.7) min, P＜0.001] 显著大于MIS-TLIF 组。[结论] PKLIF 治疗DLS 可以缓解临床症状，同时具有术中出血量少、下地时间早、住院时间短等优势。相比MIS-TLIF，不足之处是术中透视次数多、手术时间长。

Abstract:

[Objective] To compare clinical outcomes of percutaneous Kambin's triangle approach lumbar interbody fusion (PKLIF)versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis (DLS). [Methods] Aretrospective study was conducted on 32 patients who had DLS treated surgically in our hospital from March 2023 to March 2024. Accord-ing to preoperative doctor-patient communication, 15 patients received PKLIF with self-developed instruments, while other 17 patients re-ceived routine MIS-TLIF. Clinical and imaging data of the two groups were compared. [Results] All patients had the corresponding surgicalprocedures performed successfully without serious complications such as nerve injury and death, and were followed up in a mean of (6.0±1.8) months. The PKLIF group proved significantly superior to the MIS-TLIF group in terms of intraoperative blood loss [ (82.7±9.6) ml vs(165.3±25.3) ml, P＜0.001], postoperative ambulation time [(1.9±0.7) days vs (3.1±0.6) days, P＜0.001], hospital stay [(8.3±2.2) days vs(11.7±2.6) days, P＜0.001], back pain VAS score one day postoperatively [(1.8±0.7) vs (2.9±0.7), P＜0.001] and ODI score 2 weeks after op-eration [(31.2±3.0) vs (40.6±5.8), P＜0.001]. However, the PKLIF group was significantly greater than the MIS-TLIF group regarding intra-operative fluoroscopy times [(17.7±1.7) times vs (5.1±1.0) times, P＜0.001] and operation time [(134.0±12.4) min vs (115.9±13.7) min, P＜0.001]. [Conclusion] PKLIF does relieve clinical symptoms of DLS, with the advantages of less intraoperative blood loss, early ambulation,and shortened hospitalization, whereas disadvantages of more intraoperative fluoroscopy times and longer operation time compared with theMIS-TLIF.