脊柱内镜下融合术治疗腰椎滑脱症的疗效

Efficacy of endoscopic spinal fusion for lumbar spondylolisthesis

目的探讨脊柱内镜下融合术治疗腰椎滑脱症的临床疗效。方法回顾性分析52例经手术治疗的腰椎滑脱症患者的临床资料,将采用脊柱内镜下融合术治疗的26例患者纳入微创组,采用传统开放融合术治疗的26例患者纳入开放组。比较2组患者围术期指标、Oswestry功能障碍指数(ODI)、腰痛视觉模拟量表(VAS)评分、腿痛VAS评分及并发症情况,根据改良Macnab标准评价患者临床疗效。结果微创组患者术中出血量、术后引流量、住院时间均少/短于开放组,差异有统计学意义(P<0.05);但微创组手术时间较开放组长,差异有统计学意义(P<0.05)。2组术后1周、术后12个月ODI、腰痛VAS评分、腿痛VAS评分与术前比较,差异均有统计学意义(P<0.05);微创组术后1周、术后12个月腰痛VAS评分低于开放组,差异具有统计学意义(P<0.05)。2组并发症发生率比较,差异无统计学意义(P>0.05)。末次随访时,微创组疗效优良率与开放组比较,差异无统计学意义(P>0.05)。结论脊柱内镜下融合术是治疗腰椎滑脱症的有效手术方式,具有创伤小、恢复快、住院时间短等优点,近期疗效满意。

Objective To investigate the clinical efficacy of endoscopic spinal fusion for lumbar spondylolisthesis.Methods The clinical data of 52 patients with lumbar spondylolisthesis underwent surgery were retrospectively analyzed,26 patients received endoscopic spinal fusion were included in the minimally invasive group,and 26 patients received traditional open fusion were included in the open group.The perioperative indicators,Oswestry disability index(ODI),visual analogue scale(VAS)scores of low back pain and leg pain,and complications were compared in the two groups,and the clinical efficacy of the patients was evaluated according to the improved Macnab standard.Results The intraoperative blood loss,postoperative drainage volume,hospital stay of the minimally invasive group were all less/shorter than those of the open group,with statistically significant differences(P<0.05);while the operation time of the minimally invasive group was longer than that of the open group,with statistically significant difference(P<0.05).There were statistically significant differences in ODI,VAS scores of low back pain and leg pain 1 week and 12 months after surgery for patients in the two groups compared with those before surgery(P<0.05);VAS scores of low back pain 1 week and 12 months after surgery in the minimally invasive group were lower than those in the open group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).At the last follow-up,there was no statistically significant difference in the excellent and good rate of efficacy between the minimally invasive group and the open group(P>0.05).Conclusion The endoscopic spinal fusion is an effective surgical method in the treatment of lumbar spondylolisthesis,which has the advantages of small trauma,fast recovery,short hospital stay,etc.,with satisfactory short-term efficacy.