单侧双通道内镜治疗复发性腰椎间盘突出症△

Unilateral biportal endoscopic transforaminal lumbar interbody fusion for recurrent lumbar disc herniation

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 interbodyfusion, UBE-TLIF） 治疗复发性腰椎间盘突出症（recurrent lumbar disc herniation, RLDH） 的临床疗效。[方法] 回顾性分析2022年1 月—2023 年12 月本院收治的38 例RLDH 患者的临床资料。依据术前医患沟通结果，18 例行UBE-TLIF 翻修术，另外20例行开放后路腰椎间融合（posterior lumbar interbody fusion, PLIF） 翻修术。评价比较临床及影像资料。[结果] 两组患者均顺利完成手术，无神经损伤等并发症。BE-TLIF 组在手术时间[(138.3±15.4) min vs (154.8±14.6) min, P=0.002]、术中出血量[(186.1±41.0) ml vs (230.5±55.8) ml, P=0.009]、下地时间[(2.4±0.6) d vs (5.9±1.0) d, P＜0.001]、住院时间[(8.1±2.3) d vs (12.4±2.9) d, P＜0.001]均显著优于PLIF 组。随访时间平均（5.4±1.1） 个月，UBE-TLIF 组在术后1 d 腰痛VAS 评分[(2.2±0.7) vs (3.1±0.8), P=0.002]、ODI 评分[(36.7±3.4) vs (57.0±3.9), P＜0.001] 和JOA 评分[(11.2±2.4) vs (9.2±2.5), P=0.018] 均显著优于PLIF 组，但是，末次随访时，两组间上述指标的差异均无统计学意义（P＞0.05)。[结论] UBE-TLIF 组早期功能恢复优于PLIF 组，并具有手术时间短、术中出血量少、下地时间早、住院时间短等优势。

Abstract:

[Objective] To evaluate the clinical outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) for recurrent lumbar disc herniation (RLDH). [Methods] A retrospective study was conducted on 38 patients who had RLDHtreated surgically in our hospitals from January 2022 to December 2023. Based on preoperative doctor-patient communication, 18 patientsunderwent UBE-TLIF, while other 20 patients received posterior lumbar interbody fusion (PLIF). Clinical and imaging data were evaluatedand compared between the two groups. [Results] All patients in both groups were operated on successfully without neurological injury andother complications. The UBE-TLIF group proved significantly superior to the PLIF group in terms of operative time [(138.3±15.4) min vs(154.8±14.6) min, P=0.002], intraoperative blood loss [(186.1±41.0) ml vs (230.5±55.8) ml, P=0.009], the ambulation time [(2.4±0.6) daysvs (5.9±1.0) days, P＜0.001], hospital stay [(8.1±2.3) days vs (12.4±2.9) days, P＜0.001]. All patients in both groups were followed up for amean of (5.42±1.10) months. The UBE-TLIF group proved significantly better than the PLIF group regarding to back pain VAS score [(2.2±0.7) vs (3.1±0.8), P=0.002], ODI score [(36.7±3.4) vs (57.0±3.9), P＜0.001] and JOA scores [(11.2±2.4) vs (9.2±2.5), P=0.018] 1 day aftersurgery, whereas which became not statistically significant between the two groups at the latest follow-up (P＞0.05). [Conclusion] TheUBE-TLIF achieves better early functional recovery, with the advantages of shorter operation time, less intraoperative blood loss, earlierambulation time and shorter hospital stay over the PLIF.