| 摘要: |
| 目的 分析局部麻醉侧卧位内镜下腰椎椎间融合术（PE-LIF）治疗腰椎滑脱症的安全性和临床疗效。方法 回顾性分析2020年1月至2022年1月在我科行局部麻醉结合麻醉监护镇静下PE-LIF治疗的58例腰椎滑脱症患者资料。记录手术时间、术中出血量、住院时间及手术相关并发症等临床指标，采用Oswestry功能障碍指数（ODI）和疼痛视觉模拟量表（VAS）评分评估临床疗效。术前、术后1个月、术后6个月和术后1年随访时拍摄腰椎X线片，测量手术节段椎间隙高度、腰椎前凸角、手术节段前凸角。术后1个月进行腰椎CT检查，采用Gertzbein-Robbins椎弓根螺钉位置分类标准评估椎弓根螺钉置钉准确率。术后6个月、1年，通过CT检查评估椎间融合情况。结果 58例患者手术时间为130～190（160±30）min，术中出血量为52～120（63±15）mL，住院时间为6～15（9.3±3.5）d。所有患者均获得随访，随访时间为13～26（17.4±2.8）个月。术前患者腰痛VAS评分为（7.28±0.93）分，术后1年为（2.22±0.57）分；术前下肢痛VAS评分为（7.82±1.40）分，术后1年为（2.38±0.63）分；术前ODI为（65.80±9.88）%，术后1年为（12.54±4.53）%；术前患者手术节段椎间隙高度为（8.3±1.5）mm，术后1年为（10.8±1.6）mm；术前腰椎前凸角为31.7°±7.3°，术后1年为37.9°±4.4°；术前手术节段前凸角为13.1°±8.1°，术后1年为16.1°±2.4°。上述指标差异均有统计学意义（均P＜0.05）。术后1个月，椎弓根螺钉置钉总体优良率为86.64%（201/232）。术后1年时，所有病例均获得骨性融合，未发生神经根损伤、脊柱感染、椎管内血肿、融合器移位、断钉断棒等严重并发症。结论 局部麻醉PE-LIF治疗腰椎滑脱症安全、可靠。 |
| 关键词: 脊柱内镜 腰椎融合术 微创 腰椎滑脱症 局部麻醉 侧卧位 |
| DOI：10.16781/j.CN31-2187/R.20230116 |
| 投稿时间：2023-03-15修订日期：2023-07-10 |
| 基金项目:贵州省卫生健康委员会技术基金（gzwkj2023-048）．Supported by Technical Fund of Guizhou Provincial Health Commission (gzwkj2023-048). |
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| Clinical efficacy of postemlateral endoscopic lumbar interbody fusion under local anesthesia for treatment of lumbar spondylolisthesis |
| CHEN Fei*,ZHU Zeyuan,LIAO Shuliang,MA Jie,HUANG Min,YI Guoxing |
(Department of Spinal Surgery, People's Hospital of Bozhou District of Zunyi, Zunyi 563100, Guizhou, China
* Corresponding author) |
| Abstract: |
| Objective To analyze the safety and clinical effect of postemlateral endoscopic lumbar interbody fusion (PE-LIF) under local anesthesia in the treatment of lumbar spondylolisthesis. Methods The clinical data of 58 patients with lumbar spondylolisthesis treated with PE-LIF in our department from Jan. 2020 to Jan. 2022 were retrospectively analyzed. The operation time, intraoperative bleeding, hospital stay and complications were recorded. The clinical efficacy was evaluated by Oswestry dysfunction index (ODI) and visual analogue scale (VAS). Lumbar X-ray films were taken before operation, 1 month, 6 months and 1 year after operation, and the height of intervertebral space, lumbar lordosis angle and anterior lordosis angle of the surgical segment were measured. The accuracy of pedicle screw placement was evaluated by lumbar computed tomography (CT) according to the Gertzbein-Robbins pedicle screw position classification standard 1 month after operation. The fusion rate was evaluated by CT 6 months and 1 year after operation. Results The operation time of the 58 patients was 130-190 (160±30) min, the intraoperative bleeding volume was 52-120 (63±15) mL, and the hospital stay was 6-15 (9.3±3.5) d. All the patients were followed up for 13-26 (17.4±2.8) months. The VAS score of patients with low back pain was 7.28±0.93 before operation and 2.22±0.57 one year after operation, the VAS score of patients with lower limb pain was 7.82±1.40 before operation and 2.38±0.63 one year after operation, the ODI was (65.80±9.88)% before operation and (12.54±4.53)% one year after operation, the height of intervertebral space was (8.3±1.5) mm before operation and (10.8±1.6) mm one year after operation, the lumbar lordosis angle was 31.7°±7.3° before operation and 37.9°±4.4° one year after operation, and the anterior convex angle of the surgical segment was 13.1°±8.1° before operation and 16.1°±2.4° one year after operation, with significant differences in the above indexes (all P＜0.05). One month after surgery, the overall excellent and good rate of pedicle screw placement was 86.64% (201/232). One year after operation, all cases obtained bony fusion without serious complications such as nerve root injury, spinal infection, intraspinal hematoma, fusion cage displacement, or broken nails and rods. Conclusion PE-LIF under local anesthesia is safe and reliable in the treatment of lumbar spondylolisthesis. |
| Key words: spinal endoscopy lumbar fusion minimally invasive lumbar spondylolisthesis local anesthesia lateral recumbent position |
