经皮内窥镜下经椎间孔入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症

Percutaneous endoscopic transforaminal lumbar interbody fusion for degenerative lumbar spinal stenosis

目的探讨经皮内窥镜下经椎间孔入路腰椎椎间融合术(TLIF)治疗退行性腰椎椎管狭窄症(DLSS)的疗效。方法2018年10月—2019年10月,南阳市中心医院收治DLSS患者40例,采用随机数字表法分为A组(20例,采用经皮内窥镜下TLIF治疗)、B组(20例,采用传统开放TLIF治疗)。记录2组切口长度、手术时间、术中出血量、卧床时间、住院时间及并发症发生情况。记录术前及术后1、6、12个月椎间隙高度、硬膜囊横断面积、椎间孔面积评价手术减压效果。术前及术后1、6、12个月采用日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)评价腰椎功能。结果所有手术顺利完成。所有患者随访时间>12个月。A组切口长度、手术时间、术中出血量、卧床时间、住院时间及并发症发生率均优于B组,差异有统计学意义(P<0.05)。2组术后各时间点椎间隙高度、硬膜囊横断面积及椎间孔面积均较术前显著改善,差异有统计学意义(P<0.05);各时间点组间比较,差异无统计学意义(P>0.05)。2组术后各时间点JOA评分及ODI均较术前显著改善,差异有统计学意义(P<0.05);且术后各时间点A组JOA评分及ODI均优于B组,差异有统计学意义(P<0.05)。结论相较于传统开放TLIF,经皮内窥镜下TLIF治疗DLSS可有效减小手术创伤,加快恢复速度,改善腰椎功能,减少并发症的发生,且不影响减压效果。

Objective To investigate the efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion(TLIF)in the treatment of degenerative lumbar spinal stenosis(DLSS).Methods From October 2018 to October 2019,40 patients with DLSS in Nanyang Central Hospital were randomly divided into group A(20 cases,treated with percutaneous endoscopic TLIF)and group B(20 cases,treated with traditional open TLIF).The incision length,operation time,intraoperative blood loss,bed rest time,hospital stay and complications of the 2 groups were recorded.The intervertebral space height,the cross-sectional area of dural sac and the intervertebral foramen area at pre-operation and postoperative 1,6 and 12 months were recorded to evaluate the decompression effect.Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)at pre-operation and postoperative 1,6 and 12 months were used to evaluate lumbar function.Results All the operations were successfully completed.All the patients were followed up>12 months.The incision length,operation time,intraoperative blood loss,bed rest time,hospital stay and complication rate of group A were better than those of group B,and the differences were statistically significant(P<0.05).The intervertebral space height,the cross-sectional area of dural sac and the intervertebral foramen area of the 2 groups at each time point after operation were significantly improved compared with those before operation,all with a statistical significance(P<0.05);and there was no significant difference between the 2 groups at each time point after operation(P>0.05).JOA score and ODI of the 2 groups were significantly improved at each time point after operation compared with those before operation,all with a statistical significance(P<0.05);and group A were better than group B at each time point after operation,and the differences were statistically significant(P<0.05).Conclusion Compared with the traditional open TLIF,percutaneous endoscopic TLIF in the treatment of DLSS can effectively reduce the surgical trauma,accelerate the recovery speed,improve the lumbar function,reduce the occurrence of complications,and will not affect the decompression effect.