内镜与开放后路椎间融合术治疗腰椎退行疾病

Endoscopic versus open posterior lumbar interbody fusion for lumbar degenerative diseases

[目的]比较传统开放后路椎间融合(posterior lumbar interbody fusion,PLIF)内镜镜下后路椎间融合(endoscopic posterior lumbar interbody fusion,Endo-PLIF)治疗腰椎退变性疾病的临床效果。[方法] 2020年1月—2021年6月本科手术治疗的腰椎退变性疾病患者40例患者纳入本研究。依据术前医患沟通效果,20例采用Endo-PLIF术,另外20例采用传统开放PLIF术。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,术中无严重并发症。内镜组的手术时间和术中透视次数显著多于开放组(P<0.05),但是内镜组术中失血量、术后恢复下地时间和住院时间均显著优于开放组(P<0.05)。两组间切口总长度、切口愈合情况的差异无统计学意义(P>0.05)。两组患者均获随访12个月以上,内镜组恢复完全负重时间显著早于开放组(P<0.05)。随时间推移,两组腰痛VAS评分和ODI评分显著下降(P<0.05),而JOA评分均显著增加(P<0.05);出院时、术后6个月、末次随访内镜组上述评分均显著优于开放组(P<0.05)。影像方面,与术前相比,术后6个月和末次随访时,两组椎间隙高度、腰椎前凸角均显著增加(P<0.05),相应时间点两组间的差异均无统计学意义(P>0.05)。此外,相应时间点两组间Bridwell融合分级的差异无统计学意义(P>0.05)。[结论]相较于传统开放PLIF术,Endo-PLIF治疗腰椎退变性疾病疗效确切,具备创伤性低、手术出血量少、术后恢复快等优势。

[Objective]To compare clinical outcomes of endoscopic posterior lumbar interbody fusion(Endo-PLIF)versus traditional open posterior lumbar interbody fusion(PLIF)for lumbar degenerative diseases[Methods]From January 2020 to June 2021,a total of 40 patients received PLIF for lumbar degenerative diseases in our department.According to the results of preoperative doctor-patient communication,20 patients received Endo-PLIF,while the other 20 patients received traditional open PLIF.The document regarding perioperative period,follow-up and images were compared between the two groups.[Results]All patients in both groups had corresponding PLIF performed smoothly without serious complications.Although the Endo group consumed significantly longer operation time and more intraoperative fluoroscopy times than the open group(P<0.05),the former proved significantly superior to the latter in terms of intraoperative blood loss,postoperative walking time and hospital stay(P<0.05).However,there were no significant differences in the total incision length and incision healing grade between the two groups(P>0.05).All patients in both groups were followed up for more than 12 months,and the Endo group regained full weight-bearing activity significantly earlier than the open group(P<0.05).The VAS score for lower back pain and ODI score decreased significantly(P<0.05),while the JOA scores increased significantly over time in both groups(P<0.05).At discharge,6 months after surgery and at the last follow-up the Endo group was significantly better than the open group in abovesaid scores(P<0.05).Radiographically,intervertebral height and lumbar lordosis significantly increased 6 months after surgery and at the latest follow-up in both groups compared with those before surgery(P<0.05),whereas which were not significantly different between the two groups at any corresponding time points(P>0.05).In addition,there was no significant diference in Bridwell fusion grades between the two groups at the corresponding time points(P>0.05).[Conclusion] he Endo-PLIF is effective treatment forlumbar degenerative diseases,with advantages ofles trauma,less intraoperative bleeding and faster postoperative recovery over the traditional open PLIF.