单侧双通道内镜下与微创通道下经椎间孔腰椎间融合术治疗腰椎退行性疾病的疗效比较

Comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive tubular transforaminal lumbar interbody fusion for lumbar degenerative disease

目的比较单侧双通道内镜下经椎间孔腰椎间融合术(unilateral biportal endoscopic transforaminal lumbar interbody fusion,UBE-TLIF)与微创通道下TLIF(minimally invasive tubular TLIF,MT-TLIF)治疗腰椎退行性疾病的疗效。方法回顾分析2019年8月—2020年8月符合选择标准的75例腰椎退行性疾病患者临床资料,其中UBE-TLIF组35例、MT-TLIF组40例。两组患者性别、年龄、身体质量指数、疾病类型及病程、手术节段等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组手术时间、术中失血量、术前及术后1 d血红蛋白(hemoglobin,Hb)、住院时间、并发症发生情况,以及腰痛疼痛视觉模拟评分(VAS)评分、腿痛VAS评分、Oswestry功能障碍指数(ODI)、简明健康调查量表(SF-36量表)评分,手术节段椎间盘高度(intervertebral disc height,IDH)、矢状面Cobb角和腰椎前凸角(lumbar lordosis,LL),椎间融合情况。结果与MT-TLIF组相比,UBE-TLIF组手术时间更长,但术中失血量减少、住院时间缩短(P<0.05)。术后1 d两组Hb均有下降,但组间手术前后差值差异无统计学意义(P>0.05)。两组患者均获随访,UBE-TLIF组随访时间为(14.7±2.5)个月,MTTLIF组为(15.0±3.4)个月,差异无统计学意义(t=0.406,P=0.686)。临床疗效评价指标:术后两组腰痛VAS评分、腿痛VAS评分、SF-36量表评分及ODI均较术前改善(P<0.05);术后1个月及末次随访间比较差异无统计学意义(P>0.05)。手术前后各时间点两组腰痛VAS评分、腿痛VAS评分及SF-36评分比较,差异均无统计学意义(P>0.05);术后1个月UBE-TLIF组ODI优于MT-TLIF组(P<0.05)。影像学评价指标:两组术后1个月IDH、Cobb角及LL均较术前改善(P<0.05),且维持至末次随访时(P>0.05)。手术前后各时间点两组IDH、Cobb角、LL比较,差异均无统计学意义(P>0.05)。UBE-TLIF组33例(89.2%)、MT-TLIF组35例(87.5%)达植骨融合,差异无统计学意义(χ^(2)=0.015,P=0.901)。UBE-TLIF组发生术中硬膜撕裂1例、术后硬膜外血肿形成1例,并发症发生率为5.7%;MT-TLIF组发生术中硬膜撕裂1例、术后硬膜外血肿形成1例、切口浅表感染1例,并发症发生率为7.5%。两组并发症发生率比较,差异无统计学意义(χ^(2)=1.234,P=1.000)。结论与MT-TLIF相比,UBETILF治疗腰椎退行性疾病除能获得相似椎间融合效果外,还具有切口小、术中出血少、住院周期短等优点。

Objective To compare the clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF)and minimally invasive tubular TLIF(MT-TLIF)in treatment of lumbar degenerative diseases.Methods A clinical data of 75 patients with lumbar degenerative diseases,who met the selection criteria between August 2019 and August 2020,was retrospectively analyzed,including 35 patients in the UBE-TLIF group and 40 patients in the MT-TLIF group.There was no significant difference in general data such as gender,age,body mass index,disease type and duration,and surgical segment between the two groups(P>0.05),which was comparable.The operation time,intraoperative blood loss,hemoglobin(Hb)before operation and at 1 day after operation,the length of hospital stay,incidence of complications,and visual analogue scale(VAS)score of low back and leg pain,Oswestry Disability Index(ODI),Short-Form 36 Health Survey Scale(SF-36 scale),intervertebral disc height(IDH),sagittal Cobb angle,lumbar lordosis(LL),and the intervertebral fusion were compared between the two groups.Results Compared with MT-TLIF group,UBE-TLIF group had significantly longer operation time but less intraoperative blood loss and shorter length of hospital stay(P<0.05).The Hb levels in both groups decreased at 1 day after operation,but there was no significant difference in the difference before and after operation between the two groups(P>0.05).All patients were followed up,and the follow-up time was(14.7±2.5)months in the UBE-TLIF group and(15.0±3.4)months in the MT-TLIF group,with no significant difference(t=0.406,P=0.686).In both groups,the VAS score of low back pain,VAS score of leg pain,SF-36 scale,and ODI after operation significantly improved when compared with those before operation(P<0.05).There was no significant difference between 1 month after operation and last follow-up(P>0.05).There was no significant difference in the VAS score of low back pain,VAS score of leg pain,and SF-36 scale between the two groups before and after operation(P>0.05).At 1 month after operation,the ODI in the UBE-TLIF group was significantly better than that in the MT-TLIF group(P<0.05).At 1 month after operation,IDH,Cobb angle,and LL in both groups recovered when compared with those before operation(P<0.05),and were maintained until last follow-up(P>0.05).There was no significant difference in the IDH,Cobb angle,and LL between the two groups at each time point(P>0.05).Thirty-three cases(89.2%)in the UBE-TLIF group and 35 cases(87.5%)in the MT-TLIF group achieved fusion,and the difference was not significant(χ^(2)=0.015,P=0.901).In the UBE-TLIF group,1 case of intraoperative dural tear and1 case of postoperative epidural hematoma occurred,with an incidence of 5.7%.In the MT-TLIF group,1 case of intraoperative dural tear,1 case of postoperative epidural hematoma,and 1 case of superficial infection of the surgical incision occurred,with an incidence of 7.5%.There was no significant difference in the incidence of complications between the two groups(χ^(2)=1.234,P=1.000).Conclusion Compared with MT-TLIF,UBE-TILF can achieve similar interbody fusion in the treatment of lumbar degenerative diseases,and has the advantages of smaller incision,less bleeding,and shorter length of hospital stay.