单孔分体内镜辅助后外侧入路腰椎椎体间融合术治疗L_(4、5)退变性腰椎滑脱症的临床疗效分析

Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L_(4、5) degenerative lumbar spondylolisthesis

目的对比单孔分体内镜(one-hole split endoscope,OSE)辅助后外侧入路腰椎椎间融合术和传统后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗L_(4、5)退变性腰椎滑脱症(degenerative lumbar spondylolisthesis,DLS)的临床疗效。方法回顾分析2020年2月—2022年3月收治且符合选择标准的58例DLS患者,其中26例采用OSE辅助后外侧入路腰椎椎间融合术治疗(OSE组),32例采用PLIF治疗(PLIF组)。两组性别、年龄、身体质量指数、Meyerding分度、下肢症状侧别、减压侧别、狭窄类型及术前腰部疼痛视觉模拟评分(VAS)、腿痛VAS评分、Oswestry功能障碍指数(ODI)、椎间隙前缘和后缘高度等基线资料比较,差异均无统计学意义(P>0.05)。比较两组患者手术时间、术中出血量、术后住院时间、并发症;通过术前,术后1、6个月及末次随访时腰、腿痛VAS评分、ODI,术前及术后6个月、末次随访时椎间隙前缘和后缘高度,以及末次随访时改良MacNab标准评价疗效;末次随访时采用Bridwell法评估椎间融合情况。结果两组均顺利完成手术,与PLIF组相比,OSE组术中出血量、术后住院时间减少,但手术时间增加,差异均有统计学意义(P<0.05)。OSE组术中均未发生神经根损伤、硬膜囊撕裂等并发症;PLIF组发生硬膜囊撕裂、硬膜外血肿各1例,经保守治疗后治愈。两组患者均获随访,随访时间13~20个月,平均15.5个月;均无融合器松动、下沉和移位等并发症发生。两组术后各时间点腰、腿痛VAS评分、ODI及椎间隙前、后缘高度均较术前显著改善(P<0.05);除术后1个月OSE组腰痛VAS评分优于PLIF组(P<0.05)外,其余各时间点两组间各指标比较差异均无统计学意义(P>0.05)。末次随访时两组均获骨性融合,两组椎间融合情况及改良MacNab疗效评价比较差异均无统计学意义(P>0.05)。结论OSE辅助后外侧入路腰椎椎间融合术治疗L_(4、5) DLS,虽然手术时间相对较长,但术后住院时间短、并发症少,手术安全有效,早期临床疗效满意。

Objective To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope(OSE)and traditional posterior lumbar interbody fusion(PLIF)in the treatment of L_(4、5) degenerative lumbar spondylolisthesis(DLS).Methods The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed,of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion(OSE group)and 32 were treated with PLIF(PLIF group).There was no significant difference between the two groups in terms of gender,age,body mass index,Meyerding grade,lower limb symptom side,decompression side,stenosis type,and preoperative low back pain visual analogue scale(VAS)score,leg pain VAS score,Oswestry disability index(ODI),and the height of the anterior and posterior margins of the intervertebral space(P>0.05).The operation time,intraoperative blood loss,postoperative hospital stay,and complications were compared between the two groups.The low back pain and leg pain VAS scores and ODI before operation,at 1 month,6 months after operation,and last follow-up,the height of anterior and posterior margins of the intervertebral space before operation,at 6 months after operation,and last follow-up,the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness;and the Bridwell method at last follow-up was used to evaluate the interbody fusion.Results Both groups successfully completed the operation.Compared with the PLIF group,the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay,but an increase in operation time,with significant differences(P<0.05).In the OSE group,no complication such as nerve root injury and thecal sac tear occurred;in the PLIF group,there were 1 case of thecal sac tear and 1 case of epidural hematoma,which were cured after conservative management.Both groups of patients were followed up 13-20 months with an average of 15.5 months.There was no complication such as loosening,sinking,or displacement of the fusion cage.The low back pain and leg pain VAS scores,ODI,and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation(P<0.05).Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation(P<0.05),there was no significant difference in all indicators between the two groups at all other time points(P>0.05).At last follow-up,both groups achieved bone fusion,and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups(P>0.05).Conclusion OSE-assisted posterolateral approach lumbar interbody fusion for L_(4、5) DLS,although the operation time is relatively long,but the postoperative hospitalization stay is short,the complications are few,the operation is safe and effective,and the early effectiveness is satisfactory.