经皮内镜后路腰椎间融合术与微创经椎间孔入路腰椎椎间融合术治疗腰椎管狭窄症的效果

Effectiveness of percutaneous endoscopic posterior lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for lumbar canal stenosis

目的比较经皮内镜后路腰椎间融合术(percutaneous endoscopic posterior lumbar interbody fusion,PE-PLIF)和微创经椎间孔入路腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎管狭窄症的疗效差异。方法回顾性分析79例行PE-PLIF或MIS-TLIF治疗腰椎管狭窄症的患者的临床资料,对比围手术期情况及中短期疗效的差异。结果79例患者均顺利完成手术,PE-PLIF组的住院天数、术后卧床天数、术中失血量均少于MIS-TLIF组,但总费用、手术时长均多于MIS-TLIF组(P<0.05)。在术后1周,PE-PLIF组的腿痛视觉模拟评分(visual analogue scale,VAS)低于MISTLIF组,在术后1周及术后1、3月,PE-PLIF组的腰痛VAS评分低于MIS-TLIF组(P<0.05)。两组患者的术后腰椎JOA评分、椎间隙高度、椎管矢状径、改良MacNab疗效、椎间融合情况组间比较差异无统计学意义(P>0.05)。结论在合适的适应症下,在治疗腰椎管狭窄症方面,PE-PLIF与MIS-TLIF具有相似的中短期临床疗效,但在术后3个月内,PE-PLIF组的患者的症状改善程度优于MIS-TLIF组。

Objective To explore the efficacy of percutaneous endoscopic posterior lumbar interbody fusion(PE-PLIF)vs minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for lumbar canal stenosis.Methods A retrospective analysis of the clinical data of 79 patients with lumbar canal stenosis treated with PE-PLIF or MIS-TLIF was conducted.Results All patients completed the surgery successfully.The PE-PLIF group had fewer hospital days,fewer postoperative bed days,and less intraoperative blood loss than those of the MIS-TLIF group,but the total cost and length of surgery were more than those of the MIS-TLIF group,with statistically significant differences(P<0.05).The visual analogue scale(VAS)of leg pain was lower in the PE-PLIF group than that of the MIS-TLIF group at 1 week postoperatively,and the VAS score of low back pain was lower in the PE-PLIF group than that of the MIS-TLIF group at 1 week and 1 and 3 months postoperatively,with a statistically significant difference(P<0.05).No statistically significant difference was noted in the postoperative Japanese Orthopedic Association(JOA)score of the lumbar spine,intervertebral space height,sagittal diameter of the spinal canal,efficacy of modified MacNab,and intervertebral fusion between the two groups(P>0.05).Conclusion PE-PLIF and MIS-TLIF had similar short-and medium-term clinical efficacy in the treatment of lumbar canal stenosis,but patients in the PE-PLIF group showed better symptomatic improvement than that of the MIS-TLIF group at3 months postoperatively.