经皮同轴大通道内镜下与微创经椎间孔入路腰椎椎间融合术治疗退变性腰椎管狭窄症疗效比较

Comparison of effectiveness between percutaneous coaxial large-channel endoscopic lumbar interbody fusion and minimal invasive transforaminal lumbar interbody fusion in treatment of degenerative lumbar spinal stenosis

目的 比较经皮同轴大通道内镜下腰椎椎间融合术(percutaneous coaxial large-channel endoscopic lumbar interbody fusion,PE-LIF)与微创经椎间孔入路腰椎椎间融合术(minimal invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗退变性腰椎管狭窄症的疗效。方法 回顾分析2019年1月—2021年1月收治且符合选择标准的134例单节段退变性腰椎管狭窄症患者临床资料,其中PE-LIF组52例,MIS-TLIF组82例。两组患者性别、年龄、病程、手术节段及术前腰痛、下肢痛疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、术后引流量、住院时间及并发症发生情况;记录术前1 d及术后1、3 d血清肌酸激酶(creatine kinase,CK)水平评估术中肌肉损伤情况;采用Brantigan标准评价两组椎间融合情况;记录并比较两组术前1 d及术后3 d、3个月、1年的腰痛、下肢痛VAS评分,术前1 d及术后3个月、1年ODI评分。结果 两组患者手术时间和住院时间差异无统计学意义(P>0.05),PE-LIF组术中出血量及术后引流量均显著低于MIS-TLIF组(P<0.05)。术前两组患者血清CK水平差异无统计学意义(P>0.05),PE-LIF组术后1、3 d血清CK水平均显著小于MIS-TLIF组(P<0.05)。所有患者均获1年规律随访。两组术后各时间点腰痛、下肢痛VAS评分及ODI评分均较术前明显下降(P<0.05);各时间点两组间比较差异均无统计学意义(P>0.05)。术后1年PE-LIF组48例椎间融合成功,MIS-TLIF组77例椎间融合成功;两组术后3个月及1年的椎间融合分级比较差异均无统计学意义(P>0.05)。术后PE-LIF组和MIS-TLIF组分别有2例和3例发生下肢麻木,1例和3例发生神经水肿性疼痛,1例和1例发生Cage移位,1例和1例发生椎弓根螺钉松动,两组均无感染及硬膜囊撕裂发生;两组患者并发症发生率(9.6%vs.9.8%)比较差异无统计学意义(χ2=0.001,P=0.979)。结论 在治疗单节段退变性腰椎管狭窄症时,PE-LIF能达到与MIS-TLIF相似的临床疗效,且术中出血更少、肌肉损伤更小。

Objective To compare the effectiveness of percutaneous coaxial large-channel endoscopic lumbar interbody fusion(PE-LIF) and minimal invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of degenerative lumbar spinal stenosis.Methods The clinical data of 134 patients with single-segment degenerative lumbar spinal stenosis who met the selection criteria between January 2019 and January 2021 were retrospectively analyzed,including 52 cases in PE-LIF group and 82 cases in MIS-TLIF group.There was no significant difference in general data such as gender,age,disease duration,surgical segment,and preoperative visual analogue scale(VAS) scores of low back pain and lower extremity pain,and Oswestry disability index(ODI) between the two groups(P>0.05).The operation time,intraoperative blood loss,postoperative drainage,hospitalization stay,and complications were recorded and compared between the two groups.The level of serum creatine kinase(CK) was recorded at 1 day before operation and at 1 and3 days after operation to evaluate intraoperative muscle damage.The Brantigan criteria was used to evaluate the interbody fusion in the two groups.The VAS scores of low back pain and lower extremity pain at 1 day before operation and at3 days,3 months,and 1 year after operation,and the ODI scores at 1 day before operation and at 3 months and 1 year after operation were recorded and compared between the two groups.Results There was no significant difference in operation time and hospitalization stay between the two groups(P>0.05).The intraoperative blood loss and postoperative drainage in the PE-LIF group were significantly lower than those in the MIS-TLIF group(P<0.05).There was no significant difference in serum CK between the two groups before operation(P>0.05),and the serum CK in the PE-LIF group at 1 and 3 days after operation were significantly lower than those in the MIS-TLIF group(P<0.05).All patients were followed up regularly for 1 year.The postoperative VAS scores of low back pain and lower extremity pain and ODI score in both groups were significantly lower than those before operation(P<0.05);there was no significant difference between the two groups(P>0.05).At 1 year after operation,48 patients in PE-LIF group had successful interbody fusion,and 77 patients in MIS-TLIF group had successful interbody fusion.There was no significant difference in the interbody fusion distribution between the two groups at 3 months and 1 year after operation(P>0.05).There were 2 and 3 cases of lower limb numbness,1 and 3 cases of neuroedema pain,1 and 1 case of Cage displacement,1 and 1 case of pedicle screw loosening in the PE-LIF group and MIS-TLIF group,respectively.No infection or dural sac tearing occurred in the two groups.There was no significant difference in the incidence of complications between the two groups(9.6% vs.9.8%)(χ2=0.001,P=0.979).Conclusion In the treatment of single-segment degenerative lumbar spinal stenosis,PE-LIF can achieve similar effectiveness as MIS-TLIF,and PE-LIF has less intraoperative blood loss and less muscle damage.