脊柱内镜下腰椎间融合技术治疗单节段腰椎退行性疾病的临床效果

Clinical efficacy of endoscopic posterior lumbar interbody fusion in the treatment of single-level lumbar degenerative diseases

目的探讨脊柱内镜下腰椎间融合术治疗单节段腰椎退行性疾病的临床效果。方法回顾性分析陕西省宝鸡市中医医院2018年5月至2021年1月收治的48例单节段腰椎退行性疾病患者的临床资料,按手术方式不同将其分成微创组和开放组,各24例。微创组采用脊柱内镜下减压融合术治疗,开放组采用传统后路腰椎融合术治疗。比较两组围手术期指标、视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)。根据中华骨科学会脊柱学组腰背痛手术评分标准来评价患者临床疗效。结果微创组切口长度短于开放组、手术时间长于开放组、出血量少于开放组、住院时间短于开放组,差异有统计学意义(P<0.05)。组内比较:两组组内各时间点间比较差异均有统计学意义(P<0.05)。组间比较:术前,两组VAS评分及ODI指数比较,差异均无统计学意义(P>0.05),术后1周微创组VAS评分与ODI指数低于开放组(P<0.05)。术后6个月及末次随访时两组VAS评分及ODI指数比较,差异均无统计学意义(P>0.05)。两组临床疗效比较,差异无统计学意义(P>0.05)。结论脊柱内镜下腰椎减压椎间融合技术治疗单节段腰椎退行性疾病,具有组织创伤小、手术出血少、住院时间短、术后恢复快、对腰椎后方结构破坏小等优势,同时,能够达到与传统开放术式同等疗效。

Objective To investigate the clinical efficacy of endoscopic posterior lumbar interbody fusion for treatment of single-level lumbardegenerative disease.Methods The clinical data of 48 patients of single segment lumbar degenerative diseases treated in Baoji Hospital of Traditional Chinese Medicine from May 2018 to January 2021 were retrospectively analyzed.They were divided into minimally invasive group and open group according to different surgical methods,with 24 cases in each group.The minimally invasive group was treated with endoscopic posterior lumbar interbody fusion,and the open group was treated with traditional posterior lumbar fusion.The perioperative indexes,visual analogue scale(VAS)score of low back pain and Oswestry dysfunction index(ODI)were compared between the two groups.The clinical efficacy was evaluated according to the scoring standard of low back pain surgery in the spine group of Chinese orthopaedic society.Results The incision length of the minimally invasive group was shorter than that of the open group,the operation time was longer than that of the open group,the blood loss was less than that of the open group,and the length of hospital stay was shorter in the open group,and the differences were statistically significant(P<0.05).Intra-group comparison:there were statistically significant differences between the two groups at each time point(P<0.05).Comparison between groups:there were no significant differences in VAS score and ODI index between the two groups before operation(P>0.05),and the VAS score and ODI index of the micro-wound group were lower than those of the open group at one week after operation(P<0.05).However,there were no significant differences in VAS score and ODI index between the two groups at six months after operation and at the last follow-up(P>0.05).There was no significant difference in clinical efficacy between the two groups(P>0.05).Conclusion Endoscopic lumbar decompression and interbody fusion technology for the treatment of single level lumbar degenerative diseases has the advantages of small tissue trauma,less surgical bleeding,short hospital stay,fast postoperative recovery,and less damage to the posterior structure of the lumbar spine.At the same time,it can achieve similar curative effects to traditional open surgery.