| 摘要: |
| 目的 比较单边双通道内镜下经椎间孔腰椎椎体间融合术（UBE-TLIF）及传统后路腰椎椎体间融合术（PLIF）治疗单节段退行性腰椎滑脱伴腰椎管狭窄症（DLS-LSS）的临床疗效。方法 回顾性分析2020年1月至2022年1月于我院接受手术治疗的85例DLS-LSS患者的临床资料，根据所接受术式分为UBE-TLIF组（46例）和PLIF组（39例）。记录分析两组患者的一般资料、围手术期数据、影像学参数及临床疗效指标。结果 两组患者的基线特征及术前影像学参数、疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分差异均无统计学意义（均P＞0.05）。UBE-TLIF组手术时间长于PLIF组［（156.42±26.65）min vs （141.36±21.46）min，P＝0.006］，术中出血量少于PLIF组［（170.15±10.87）mL vs （203.15±15.67）mL，P＜0.001］，住院时间短于PLIF组［（6.73±2.42）d vs （9.61±2.56）d，P＜0.001］。UBE-TLIF组的腰椎前凸角及节段角在术后3个月［（42.52±8.57）° vs （46.61±7.31）°、（10.93±2.59）° vs （12.16±3.05）°］及末次随访时［（41.35±7.46）° vs （44.62±6.42）°、（10.65±2.43）° vs （11.87±2.53）°］均小于PLIF组（均P＜0.05）。UBE-TLIF组术后3个月融合率低于PLIF组［34.78%（16/46） vs 58.97%（23/39），P＜0.05］，末次随访时融合率差异无统计学意义［93.48%（43/46） vs 94.87%（37/39），P＞0.05］。UBE-TLIF组术后3个月VAS评分及ODI评分均低于PLIF组［（2.43±0.92）分vs （3.12±1.03）分、（26.81±9.14）分vs （33.35±8.76）分，均P＜0.01］，末次随访时比较差异均无统计学意义（均P＞0.05）。结论 UBE-TLIF作为一种微创手术技术，具有创伤小、恢复快、术后疼痛轻、融合率可靠等优点，是一种值得推广的治疗DLS-LSS的有效方法。 |
| 关键词: 退行性腰椎滑脱 腰椎管狭窄症 单边双通道内镜 后路腰椎椎体间融合术 |
| DOI：10.16781/j.CN31-2187/R.20240549 |
| 投稿时间：2024-08-05修订日期：2024-10-30 |
| 基金项目:上海市自然科学基金（22ZR1476600）. |
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| Efficacy of unilateral biportal endoscopy versus traditional posterior lumbar interbody fusion surgery in treating single-segment degenerative lumbar spondylolisthesis with lumbar spinal stenosis |
| LU Chunwen△,WANG Hui△,WU Hongri,DU Shiyao,WANG Zhenwei,XU Tianming* |
(Department of Orthopedics, No. 905 Hospital, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) & Department of Orthopedics, No. 905 Hospital of PLA Navy, Shanghai 200050, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To compare the clinical efficacy of transforaminal lumbar interbody fusion under unilateral biportal endoscopy (UBE-TLIF) and traditional posterior lumbar interbody fusion (PLIF) in treating single-segment degenerative lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). Methods The clinical data of 85 patients diagnosed with DLS-LSS who underwent surgery between Jan. 2020 and Jan. 2022 in our hospital were retrospectively analyzed. Patients were assigned to UBE-TLIF group (46 cases) and PLIF group (39 cases) based on the surgical procedure. The general characteristics, perioperative data, radiological parameters, and clinical efficacy indicators were analyzed. Results There were no significant differences in baseline characteristics, preoperative radiological parameters, pain visual analogue scale (VAS) score, or Oswestry disability index (ODI) score between the 2 groups (all P＞0.05). Compared with the PLIF group, the UBE-TLIF group had significantly longer operation time (［156.42±26.65］ min vs ［141.36±21.46］ min, P＝0.006), significantly less operation blood loss (［170.15±10.87］ mL vs ［203.15±15.67］ mL, P＜0.001), and significantly shorter hospital stay (［6.73±2.42］ d vs ［9.61±2.56］ d, P＜0.001). The UBE-TLIF group had significantly smaller lumbar lordosis and segmental angle 3 months postoperatively (［42.52±8.57］° vs ［46.61±7.31］°, ［10.93±2.59］° vs ［12.16±3.05］°) and at final follow-up (［41.35±7.46］° vs ［44.62±6.42］°, ［10.65±2.43］° vs ［11.87±2.53］°) compared with the PLIF group (all P＜0.05). The fusion rate was significantly lower in the UBE-TLIF group compared with the PLIF group 3 months after operation (34.78% ［16/46］ vs 58.97% ［23/39］, P＜0.05), with no significant difference at final follow-up (93.48% ［43/46］ vs 94.87% ［37/39］, P＞0.05). The VAS score and ODI score 3 months after operation were significantly lower in the UBE-TLIF group compared with the PLIF group (2.43±0.92 vs 3.12±1.03, 26.81±9.14 vs 33.35±8.76, both P＜0.01), with no significant differences at final follow-up (both P＞0.05). Conclusion As a minimally invasive surgical technique, UBE-TLIF has the advantages of minimal trauma, fast recovery, mild postoperative pain, and a reliable fusion rate. It is an effective treatment for DLS-LSS and deserves to be promoted. |
| Key words: degenerative lumbar spondylolisthesis lumbar spinal stenosis unilateral biportal endoscopy posterior lumbar interbody fusion |
