双通道镜下腰椎间融合术治疗退变性腰椎疾病的手术要点和早期疗效

doi:10.13418/j.issn.1001-165x.2020.06.015

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (6) : 703-708. DOI: 10.13418/j.issn.1001-165x.2020.06.015

梁昌详，　郑晓青，　肖丹，　黄勇兄，　梁国彦，　陈崇，　尹东，　昌耘冰

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Surgical essentials and early clinical effects of biportal endoscopic lumbar intervertebral fusion in the treatment of degenerative lumbar disease

LIANG Chang-xiang, ZHENG Xiao-qing, XIAO Dan, HUANG Yong-xiong, LIANG Guo-yan, CHEN Chong, YIN Dong, CHANG Yun-bing

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摘要

目的　介绍双通道镜下腰椎间融合术（biportal endoscopic lumbar intervertebral fusion，BELIF）的手术要点，报道短期临床疗效及手术并发症。方法　54例患者（男性24例，女性30例，年龄38~79岁）接受BELIF术并随访3个月以上的。记录术前术后腰腿痛VAS及ODI评分。统计总手术时间，镜下操作时间，记录围手术期并发症，计算围手术期失血量，测量植骨区域占总椎间盘面积的百分比。结果　腰疼VAS评分由术前（6.13±0.64）分改善至末次随访时的（2.21±1.04）分（P<0.05），ODI评分由术前（46.54±13.75）改善至（14.78±9.23）（P<0.05）。平均手术时间164 min，平均镜下时间102 min。平均出血量为（156±31）ml。平均植骨面积（48.5±9.4）%。未出现严重并发症。结论　BELIF术短期临床疗效好，并发症少，是一种兼顾微创，安全及效率的腰椎融合手术。

Abstract

Objective　To introduce and discuss surgical highlights and advantages of BELIF (Biportal Endoscopic Lumbar Intervertebral Fusion), its short-term clinical therapeutic efficacy and potential surgical complications.　Methods　BELIF surgery was performed on 54 patients (Male: 24 cases, female: 30 cases, age: 38~79 years old) and they were followed-up at least 3 months. The VAS and ODI scores were recorded before and afer surgery. The total operation time and microscopic operation time，the perioperative complications of the patients and the perioperative bleeding volume were recorded and calculated. The percentage of bone graft area in the total intervertebral disc area was measured. Results The VAS score of low back pain improved from (6.13±0.64) before operation to (2.21±1.04) the last follow-up (P<0.05). The ODI score improved from (46.54±13.75) before operation to (14.78±9.23) (P<0.05). The average operation time was 164 min and the average endoscopic time was 102 min. The average bleeding volume was (156±31) ml. The average area of bone graft was (48.5±9.4)%. There was no serious complications. Conclusions BELIF is a minimally invasive, safe and efficient lumbar fusion surgery with good short-term clinical effect and few complications.

导出引用

梁昌详, 郑晓青, 肖丹, 黄勇兄, 梁国彦, 陈崇, 尹东, 昌耘冰. 双通道镜下腰椎间融合术治疗退变性腰椎疾病的手术要点和早期疗效[J]. 中国临床解剖学杂志. 2020, 38(6): 703-708 https://doi.org/10.13418/j.issn.1001-165x.2020.06.015

LIANG Chang-xiang, ZHENG Xiao-qing, XIAO Dan, HUANG Yong-xiong, LIANG Guo-yan, CHEN Chong, YIN Dong, CHANG Yun-bing. Surgical essentials and early clinical effects of biportal endoscopic lumbar intervertebral fusion in the treatment of degenerative lumbar disease[J]. Chinese Journal of Clinical Anatomy. 2020, 38(6): 703-708 https://doi.org/10.13418/j.issn.1001-165x.2020.06.015

中图分类号： R681.53

参考文献

[1] Ahn Y, Youn MS, Heo DH. Endoscopic transforaminal lumbar interbody fusion: a comprehensive review[J]. Expert Rev Med Devices, 2019, 16(5): 373-380.
[2] Wu JL, Liu H, Ao SX, et al. Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-year follow-up[J]. Biomed Res Int, 2018, 2018: 5806037.
[3] Kolcun JPG, Brusko GD, Basil GW, et al. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up[J]. Neurosurg Focus, 2019, 46(4): E14.
[4] Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it[J]? Int Orthop, 2013, 37(8): 1507-1510.
[5] Youn MS, Shin JK, Goh TS, et al. Full endoscopic lumbar interbody fusion (FELIF): technical note[J]. Eur Spine J, 2018, 27(8): 1949-1955.
[6] Yang JC. [Current problems and challenges for percutaneous endoscopic transforaminal lumbar interbody fusion][J]. Zhonghua Yi Xue Za Zhi, 2019, 99(33): 2566-2568.
[7] Pao JL, Lin SM, Chen WC, et al. Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis[J]. J Spine Surg, 2020, 6(2): 438-446.
[8] Heo DH, Lee N, Park CW, et al. Endoscopic unilateral laminotomy with bilateral discectomy using biportal endoscopic approach: technical report and preliminary clinical results[J]. World Neurosurg, 2020, 137: 31-37.
[9] Park MK, Park SA, Son SK, et al. Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up[J]. Neurosurg Rev, 2019,42(3):753-761.
[10] Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults[J]. Surgery, 1962, 51(2): 224-232.
[11] Smorgick Y, Baker KC, Fischgrund JS. Hidden blood loss during posterior spine fusion surgery: in response to the letter by ZhiNan et al[J]. Spine J, 2015, 15(9): 2114-2115.
[12]Hasegawa T, Ushirozako H, Shigeto E, et al. The titanium-coated PEEK cage maintains better bone fusion with the endplate than the PEEK cage 6 months after PLIF surgery: a multicenter, prospective, randomized study[J]. Spine (Phila Pa 1976), 2020,45(15):E892-E902.
[13]Tsutsumimoto T, Shimogata M, Ohta H, et al. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction[J]. Spine (Phila Pa 1976), 2009, 34(18): 1923-1928.
[14]Ge DH, Stekas ND, Varlotta CG, et al. Comparative analysis of two transforaminal lumbar interbody fusion techniques: open TLIF versus wiltse MIS TLIF[J]. Spine (Phila Pa 1976), 2019, 44(9): E555-E560.
[15]Tan JH, Liu G, Ng R, et al. Is MIS-TLIF superior to open TLIF in obese patients? A systematic review and meta-analysis[J]. Eur Spine J, 2018, 27(8): 1877-1886.
[16]Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results[J]. Neurosurg Focus, 2017, 43(2): E8.
[17]Soliman HM. Irrigation endoscopic decompressive laminotomy. A new endoscopic approach for spinal stenosis decompression[J]. Spine J, 2015, 15(10): 2282-2289.
[18]Nakamura S, Taguchi M. Full percutaneous lumbar interbody fusion: technical note[J]. J Neurol Surg A Cent Eur Neurosurg, 2017, 78(6): 601-606.
[19]Lee SH, Erken HY, Bae J. Percutaneous transforaminal endoscopic lumbar interbody fusion: clinical and radiological results of mean 46-month follow-up[J]. Biomed Res Int, 2017, 2017: 3731983.
[20]Shen J. Fully endoscopic lumbar laminectomy and transforaminal lumbar interbody Fusion under local anesthesia with conscious sedation: a case series[J]. World Neurosurg, 2019, 127: e745-e750.
[21] Kim JE, Choi DJ, Park EJJ, et al. Biportal endoscopic spinal surgery for lumbar spinal stenosis[J]. Asian Spine J, 2019, 13(2): 334-342.