全内镜下腰椎椎间融合术治疗腰椎退行性病变伴腰椎失稳的早期临床疗效

Early efficacy of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability

目的探讨全内镜下腰椎椎间融合术治疗腰椎退行性病变伴腰椎失稳的早期临床疗效。方法回顾分析2019年1月至2020年6月空军军医大学唐都医院骨科采用全内镜下腰椎椎间融合术治疗腰椎退行性病变伴腰椎失稳的患者22例,记录手术时间、术中出血量、住院时间等指标,评估比较术前、术后1周、术后1个月、术后3个月、术后6个月及末次随访时腰腿痛视觉疼痛模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI),末次随访时采用改良MacNab疗效评定标准评价临床疗效。结果22例患者均顺利完成手术。手术时间180~240 min,平均(206.59±15.69)min;术中出血量50~120 mL,平均(92.73±22.29)mL;住院时间7~13 d,平均(8.82±1.53)d;随访时间6~18个月,平均(10.95±3.34)个月。术后各时间点腰腿痛VAS评分和ODI与术前相比,均明显降低,差异有统计学意义(P均<0.05)。末次随访时改良MacNab疗效评定:优17例、良3例、可2例,优良率为90.91%。结论全内镜下腰椎椎间融合术治疗腰椎退行性病变伴腰椎失稳的早期临床疗效满意。

Objective To investigate the early clinical efficacy of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability.Methods We made a retrospective analysis of 22 cases of lumbar degenerative diseases with lumbar instability treated by full endoscopic lumbar interbody fusion in Department of Orthopedics,Tangdu Hospital of Air Force Military Medical University from January 2019 to June 2020.The operation time,intraoperative bleeding volume,and hospital stay were recorded.The Visual Analogue Scale(VAS)for lower back pain and leg pain and Oswestry disability index(ODI)were compared before operation,1 week,1 month,3 months,6 months and at the last follow-up after operation.Modified MacNab was used to evaluate the clinical efficacy at the last follow-up.Results Operations on the 22 patients were all completed successfully.The average operation time was(206.59±5.69)min(with the range of 180-240 min);the average volume of intraoperative bleeding was(92.73±22.29)mL(with the range of 50-120 mL);the average hospitalization time was(8.82±1.53)d(with the range of 7-13 d).All the patients were followed up for an average of(10.95±3.34)months(with the range of 6-18 months).The VAS score and ODI at each time point after surgery were significantly decreased compared with those before operation(P<0.05).The modified MacNab used to evaluate the clinical efficacy at the last follow-up showed that the total excellent and good rate was 90.91%,including 17 cases of excellence,3 cases of good,and 2 cases of fair.Conclusion The early clinical effect of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability is satisfactory.