内镜下椎间融合联合经皮椎弓根钉内固定治疗退行性腰椎滑脱合并腰椎管狭窄的疗效

Efficacy of endoscopic lumbar interbody fusion combined with percutaneous pedicle screw fixation in the treatment of degenerative lumbar spondylolisthesis with stenosis

目的评价内镜下椎间融合联合经皮椎弓根内固定术治疗退行性腰椎滑脱合并腰椎管狭窄的临床治疗效果。方法回顾性分析2016年6月至2019年6月我科收治的退行性腰椎滑脱合并腰椎管狭窄病人78例,均采用内镜下椎间融合联合经皮椎弓根钉内固定术进行治疗,收集手术时间、术中出血量、住院时间等围手术期相关数据,比较手术前后的Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟量表(visual analogue scale,VAS)评分、椎体滑移距离和硬膜囊横断面积。结果本组手术时间为(118.2±17.3)min,术中出血量为(47.4±13.8)ml,住院时间为(5.2±2.4)d。随访时间为(15.3±3.6)个月。VAS评分由术前的(6.8±1.4)分降低至术后12个月随访的(1.4±1.1)分,ODI由术前的60.3%±11.5%降低至术后12个月随访的19.6%±6.7%,椎体滑移距离由术前的(4.7±1.6)mm降低至术后12个月随访的(0.7±0.2)mm,硬膜囊横断面积由术前的(75.9±18.2)mm2增加至术后12个月随访的(159.9±18.4)mm2,术后1周、3个月、12个月的VAS评分、ODI、椎体滑移距离、硬膜囊横断面积与术前数值比较,差异均有统计学意义(P均<0.05)。根据Bridwell椎间融合标准,术后12个月达到Ⅰ级融合病人71例(91.0%),Ⅱ级融合7例(9.0%)。结论内镜下椎间融合联合经皮椎弓根内固定术治疗退行性腰椎滑脱合并腰椎管狭窄可以取得满意的治疗效果,远期效果仍需进一步证实。

Objective To evaluate the clinical efficacy of endoscopic lumbar interbody fusion combined with percutaneous pedicle screw fixation in the treatment of degenerative lumbar spondylolisthesis with stenosis.Methods A retrospective analysis of 78 patients with lumbar spondylolisthesis with stenosis treated by endoscopic lumbar interbody fusion combined with percutaneous pedicle screw fixation in our hospital from June 2016 to June 2019 was conducted.Perioperative information was recorded and analyzed,as well as time of surgery,Oswestry disability index(ODI),visual analogue scale(VAS),the sliding distance of vertebral and the area of dural sac.Statistical analysis was done.Results The operation time was(118.2±17.3)min,volume of bleeding during surgery was(47.4±13.8)ml,hospital stay was(5.2±2.4)days.All patients were followed up for(15.3±3.6)months.VAS score decreased from 6.8±1.4 before surgery to 1.4±1.112 months after surgery;ODI decreased from 60.3%±11.5%before surgery to 19.6%±6.7%12 months after surgery;the sliding distance of vertebral decreased from(4.7±1.6)mm before surgery to(0.7±0.2)mm 12 months after surgery;the area of dural sac increased from(75.9±18.2)mm2 before surgery to(159.9±18.4)mm212 months after surgery.There were significant differences in VAS score,ODI,the sliding distance of vertebral and the area of dural sac between 1 week,3 months and 12 months after operation and preoperation(all P<0.05).According to the Bridwell fusion grading system,71 patients(91.0%)achieved gradeⅠfusion and 7 patients(9.0%)achieved gradeⅡfusion during the follow⁃up period of 12 months.Conclusion Endoscopic lumbar interbody fusion combined with percutaneous pedicle screw fixation can achieve satisfactory results in the treatment of degenerative lumbar spondylolisthesis with stenosis.The long⁃term clinical effect should be focused on in the further study.