DELTA内镜下腰椎间融合术治疗腰椎滑脱症的临床疗效分析

Clinical efficacy analysis of DELTA endoscopic lumbar interbody fusion for the treatment of lumbar spondylolisthesis

目的探讨DELTA内镜下腰椎间融合术治疗轻中度、单节段腰椎滑脱症的临床疗效。方法回顾性分析2020年2月至2022年3月湖南中医药大学第一附属医院收治的48例Ⅰ~Ⅱ度腰椎滑脱症手术病例的临床资料,其中采用DELTA内镜下腰椎间融合术治疗的24例为DELTA组,采用传统微创经椎间孔入路腰椎椎间融合(MIS-TLIF)术式治疗的24例为MIS-TLIF组。比较两组患者围手术期指标(手术时间、术后引流量、切口长度、住院时间)、临床疗效(腰腿痛VAS评分、腰椎JOA评分、改良MacNab标准优良率)以及腰椎融合率(Bridwell椎间融合分级)。结果DELTA组手术时间长于MIS-TLIF组,术后引流量、切口长度、住院时间均少于MIS-TLIF组,差异有统计学意义(均P<0.05)。两组患者在术后1周、3个月、末次随访时的腰腿痛VAS评分、腰椎JOA评分均较术前明显改善,差异有统计学意义(均P<0.01),且DELTA组术后各时点的腰腿痛VAS评分、腰椎JOA评分均优于MIS-TLIF组,差异有统计学意义(均P<0.05)。术后末次随访时采用改良MacNab标准评价疗效,两组患者优良率差异无统计学意义(P>0.05);Bridwell椎间融合率差异亦无统计学意义(P>0.05)。结论DELTA内镜下腰椎间融合术治疗腰椎滑脱症疗效显著,其优势在于手术切口小、康复快等方面;在跨越DELTA内镜学习曲线和优化手术流程后,该项技术可以成为MIS-TLIF技术的替代方案。

Objective To explore the clinical efficacy of DELTA endoscopic lumbar interbody fusion for the treatment of mild to moderate,single segment lumbar spondylolisthesis.Methods A retrospective analysis was conducted on the clinical data of 48 surgical cases of gradeⅠtoⅡlumbar spondylolisthesis admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from February 2020 to March 2022.Among them,24 cases treated with DELTA endoscopic lumbar interbody fusion surgery were classified as the DELTA group,and 24 cases treated with traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)surgery were classified as the MIS-TLIF group.Two groups of patients were compared in terms of perioperative indicators(surgical time,postoperative drainage volume,incision length,hospital stay),clinical efficacy[Visual Analogue Scale(VAS)score for low back and leg pain,lumbar Japanese Orthopaedic Association Scores(JOA),improved MacNab standard excellence rate],and lumbar fusion rate(Bridwell intervertebral fusion grade).Results The DELTA group had longer surgical time than the MIS-TLIF group,and the postoperative drainage volume,incision length,and hospital stay were all lower than the MIS-TLIF group,with statistically significant differences(all P<0.05).The VAS score of lower back and leg pain and lumbar JOA score of the two groups of patients at 1 week,3 months,and the last follow-up were significantly improved compared to those before surgery(all P<0.01),and the DELTA group had better VAS score of lower back and leg pain and lumbar JOA score at all time points after surgery than the MIS-TLIF group,with statistically significant differences(all P<0.05).The improved MacNab standard was used to evaluate the efficacy of the two groups of patients at the last follow-up after surgery,and there was no statistically significant difference in the excellent and good rates(P>0.05);There was no statistically significant difference(P>0.05)in the fusion rate between the two groups.Conclusions DELTA endoscopic lumbar interbody fusion has a significant therapeutic effect on lumbar spondylolisthesis,with the advantages of small surgical incision and fast recovery;After crossing the DELTA endoscopic learning curve and optimizing surgical procedures,this technology can become an alternative to MIS-TLIF technology.