两种手术方式治疗单节段腰椎管狭窄症的早期疗效比较

Comparison of early effect of two kinds of surgery methods in the treatment of single-level lumbar spinal stenosis

目的比较经椎间孔入路腰椎椎间植骨融合术(TLIF)和经皮脊柱内镜下TLIF(Endo-TLIF)治疗单节段腰椎管狭窄症的疗效。方法将44例单节段腰椎管狭窄症患者根据治疗方法的不同分为Endo-TLIF组(20例,采用Endo-TLIF治疗)和TLIF组(24例,采用TLIF治疗)。比较两组手术情况,采用疼痛VAS评分评价疼痛改善情况,采用ODI评定功能障碍情况,根据SUK方法判断术后骨融合情况。结果患者均获得随访,时间3~21(13.2±3.2)个月。Endo-TLIF组未发生术中脑脊液漏、神经损伤及术后切口感染、慢性腰背痛、后凸畸形等情况,3例在腰椎旋转时出现特定位置的腰痛;TLIF组1例术中脑脊液漏,1例切口感染。手术时间两组比较差异无统计学意义(P>0.05)。术中出血量、住院时间、住院费用Endo-TLIF组均少(短)于TLIF组(P<0.05)。末次随访时疼痛VAS评分、ODI、椎间孔高度、椎间孔宽度、椎间隙高度两组均较术前改善(P<0.05),两组比较差异均无统计学意义(P>0.05)。末次随访时,Endo-TLIF组未融合1例,TLIF组未融合2例。结论与TLIF比较,Endo-TLIF治疗腰椎管狭窄症是可行和有效的,具有手术创伤小、出血少、术中视野良好、神经损伤风险低、椎间植骨量充足等优点。

Objective To compare the efficacy of transforaminal lumbar interbody fusion(TLIF)and percutaneous spinal endoscopic TLIF(Endo-TLIF)in the treatment of single-level lumbar spinal stenosis.Methods Forty-four patients with single-level lumbar spinal stenosis were divided into Endo-TLIF group(20 cases,treated with Endo-TLIF)and TLIF group(24 cases,treated with TLIF),according to different treatment methods.The surgery situation was compared between two groups,pain VAS was used to evaluate the improvement of pain,ODI was used to evaluate the dysfunction,and SUK method was used to judge the postoperative bone fusion situation.Results All patients were followed up for 3~21(13.2±3.2)months.In Endo-TLIF group,there were no intraoperative cerebrospinal fluid leakage and nerve injury,postoperative incision infection,chronic low back pain and kyphosis;and 3 cases had low back pain at specific position during lumbar rotating.In TLIF group,there was 1 case of intraoperative cerebrospinal fluid leakage and incision infection,respectively.There was no significant difference in operation time between the two groups(P>0.05).The volume of intraoperative blood loss,length of hospital stay and hospitalization cost in Endo-TLIF group were lower(shorter)than those in TLIF group(P<0.05).At the last follow-up,the pain VAS,ODI,foraminal height,foraminal width and intervertebral space height were all improved in the two groups,compared with those before operation(P<0.05),there were no significant differences between the two groups(P>0.05).At the last follow-up,there were 1 case of non-fusion in Endo-TLIF group and 2 cases of non-fusion in TLIF group.Conclusions Compared with TLIF,Endo-TLIF is feasible and effective in the treatment of lumbar spinal stenosis,which has more advantages of less surgical trauma,less bleeding,good intraoperative visual field,low risk of nerve injury and sufficient intervertebral bone grafting.