目的 分析比较显微内窥镜下两种不同腰椎椎间融合手术技术治疗单节段腰椎退变性疾病的临床疗效。 方法 选取我院2020年12月至2023年12月间符合标准的136例患者进行回顾性研究。75例患者接受显微内镜下经椎间孔入路椎体间融合术（microendoscopic tranforaminal lumbar interbody fusion，ME-TLIF），61例患者行显微内镜下经后方入路椎体间融合术（microendoscopic posterior lumbar interbody fusion，ME-PLIF）。对两组围手术期资料及神经系统并发症发生情况进行比较。在手术前后对组内和组间的疼痛（VAS）及功能（ODI）评分进行比较。采用Suk标准评价术后融合情况。 结果 ME-PLIF 组患者在术中出血量、术后引流量、手术时间等指标方面，均优于ME-TLIF组。ME-PLIF 组术中出现3例神经系统并发症，ME-TLIF组无神经系统并发症。同组患者术后VAS及ODI分值与术前相比较差异有统计学意义（P<0.05）；组间术后VAS及ODI分值改变无统计学意义（P>0.05）。末次随访时两组融合率基本无差异。 结论 ME-PLIF 技术在减少手术时间，降低术中及术后出血量方面更有优势，更容易学习掌握，在手术中要注意向外侧的充分减压防止神经并发症的发生。
Abstract
Objective To analyze and compare the clinical efficacy of two different lumbar interbody fusion techniques under microendoscope in the treatment of single level lumbar degenerative diseases. Methods A total of 136 patients who met the criteria in our hospital from December 2020 to December 2023 were selected for retrospective study. Seventy-five patients received microendoscopic tranforaminal lumbar interbody fusion (ME-TLIF) and 61 patients received microendoscopic posterior lumbar interbody fusion (ME-PLIF). The perioperative data and the incidence of neurological complications were compared between the two groups. Pain (VAS) and function (ODI) scores within and between groups were compared before and after surgery. Suk criteria were used to evaluate postoperative fusion. Results The indexes of intraoperative blood loss, postoperative drainage volume and operation time in ME-PLIF group were better than those in ME-TLIF group. There were 3 cases of neurological complications in the ME-PLIF group and no neurological complications in the ME-TLIF group. Postoperative VAS and ODI scores in the same group were significantly different from those before surgery (P<0.05); Postoperative VAS and ODI scores were not significantly changed between groups (P>0.05). There was no difference in the fusion rate between the two groups at the last follow-up. Conclusions ME-PLIF technique has more advantages in reducing operation time, intraoperative and postoperative blood loss, and is easier to learn and master. During the operation, attention should be paid to adequate lateral decompression to prevent the occurrence of neurological complications.
关键词
显微内窥镜 /
微创 /
后路腰椎融合 /
经椎间孔腰椎融合 /
退变性疾病
Key words
Microendoscope /
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Minimally invasive /
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Posterior lumbar fusion /
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Transforaminal lumbar fusion /
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Degenerative disease
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参考文献
[1] 孙秀民, 徐宏光, 肖良, 等. 斜外侧腰椎椎间融合术后脊柱-骨盆矢状位参数变化与临床疗效的相关性研究[J].中国骨伤, 2020, 33(7): 609-614. DOI:10.12200/j.issn.1003-0034.2020.07.004.
[2] 陈勇喜,付拴虎,卢大汉,等.高龄腰椎管狭窄症及其脊柱内镜治疗的研究进展[J].微创医学, 2023, 18(3):344-347. DOI:10.11864/j.issn．1673.2023.03.16.
[3] 王准, 贺永进. 经皮脊柱内镜TESSYS技术治疗腰椎间盘突出症的临床应用进展[J]. 河北医科大学学报, 2024, 45(1):47-52. DOI:10．3969/j.issn.1007-3205.2024.01.010.
[4] 向刚刚, 曹鹏, 高启龙, 等. UBE与MED两种术式辅助治疗腰椎管狭窄症的中远期疗效比较[J]. 包头医学院学报, 2024, 40(1):41-46. DOI:10.16833/j.cnki.jbmc.2024.01.007.
[5] 徐梓耀, 兰浩昌, 慈丽纹. 腰椎退行性脊柱侧凸术后邻椎病情况及危险因素分析[J]. 颈腰痛杂志, 2023, 44(4):650-653. DOI :10.3969/j．issn．1005-7234.2023.04.042.
[6] 汪大伟, 王华东, 李利, 等. 自体下关节突骨块应用于骨质疏松患者腰椎椎间融合术的疗效分析[J]. 北京大学学报(医学版), 2023, 55(5):899-909. DOI:10.19723/j.issn.1671-167X.2023.05.019.
[7] 翟正佳, 董健文, 刘仲宇, 等. 三维CT导航与传统X线透视引导脊柱内镜下腰椎椎间融合术的比较研究[J]. 中华骨与关节外科杂志,2023,16(3):239-245. DOI:10.3969/j.issn.2095-9958.2023.03.08.
[8] 黄莹, 祝明秋. 基于IMB理论与护理解剖知识的健康教育在MIS-TLIF围术期中的应用[J].全科护理,2024,22(3):489-493. DOI:10.12104/j.issn.1674-4748.2024.03.023.
[9] 施耀华, 杨建平, 赵洪, 等.显微镜辅助微创经椎间孔腰椎椎间融合术治疗单节段腰椎滑脱症[J]. 国际骨科学杂志, 2024, 45(1):62-67. DOI: 10.3969/j. issn. 1673-7083. 2024.01.014.
[10]Sharif S, Afsar A. Learning Curve and Minimally Invasive Spine Surgery [J] . World Neurosurg, 2018,119: 472-478.DOI: 10.1016/j.wneu.2018.06.094.
[11]雷登强, 贺元, 阿海, 等.全内窥镜下后方经椎板间入路腰椎椎间融合术治疗单节段腰椎退行性疾病[J].脊柱外科杂志, 2024, 22(1):12-15+31. DOI: 10.3969/j.issn.1672-2957.2024.01.003.
[12]Peng P, Chen K, Chen H, et al. Comparison of O-arm navigation and microscope- assisted minimally invasive transforaminal lumbar interbody fusion and conventional transforaminal lumbar interbody fusion for the treatment of lumbar isthmic spondylolisthesis [J] . J Orthop Translat, 2020,20(1):107-112. DOI: 10.1016/j.jot. 2019. 10.001.
[13]林顺, 刘锦涛, 姜宏, 等. 内镜椎间盘切除术后残留症状原因与处理[J].中国矫形外科杂志, 2024, 32(1): 61-66. DOI:10.3977/j.issn.1005-8478.2024.01.10.
[14]李亮, 梁梅, 王聪聪, 等. 3D打印辅助置钉联合改良PLIF在退行性脊柱侧弯矫形中的应用[J]. 实用骨科杂志, 2023, 29(12):1062-1069.DOI:10.13795/j.cnki.sgkz.2023.12.002.
基金
内蒙古自治区科技计划项目（2021GG0395）；内蒙古医科大学“致远”人才计划（ ZY0110019）
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