单侧双通道脊柱内镜腰椎融合术与单通道脊柱内镜下经椎间孔腰椎融合术治疗合并椎间盘突出的腰椎管狭窄症疗效比较研究

Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation

目的比较单侧双通道脊柱内镜腰椎融合术(unilateral biportal endoscopic lumbar interbody fusion,ULIF)与单通道脊柱内镜下经椎间孔腰椎融合术(endoscopic transforaminal lumbar interbody fusion,Endo-TLIF)治疗合并椎间盘突出的腰椎管狭窄症疗效。方法回顾分析2020年4月—2021年11月64例符合选择标准的合并椎间盘突出的腰椎管狭窄症患者临床资料。其中,采用ULIF治疗30例(ULIF组)、Endo-TLIF治疗34例(Endo-TLIF组)。两组患者性别、年龄、病程、病变节段以及术前腰、腿痛疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎管面积、椎间隙高度等基线资料比较,差异均无统计学意义(P>0.05)。比较两组手术时间、术中出血量、住院时间以及术后并发症发生情况,腰、腿痛VAS评分以及ODI,以及影像学测量指标,包括椎管面积、椎间植骨面积、椎间隙高度、椎间融合情况(改良Brantigan评分)。结果与Endo-TLIF组相比,ULIF组手术时间缩短,但术中出血量较多、患者住院时间较长,差异均有统计学意义(P<0.05)。术后EndoTLIF组、ULIF组分别有2、1例发生脑脊液漏,均无其他并发症发生;两组并发症发生率差异无统计学意义(P>0.05)。两组患者均获随访12个月。术后两组腰、腿痛VAS评分及ODI均较术前改善(P<0.05),术后各时间点间比较差异无统计学意义(P>0.05);术后各时间点两组间比较差异均无统计学意义(P>0.05)。影像学检查示,两组术后椎管面积变化值、椎间隙高度变化值以及术后6、12个月椎间融合率比较,差异无统计学意义(P>0.05);ULIF组椎间植骨面积大于Endo-TLIF组,差异有统计学意义(P<0.05)。结论对于合并椎间盘突出的腰椎管狭窄症患者,ULIF不仅能获得与Endo-TLIF相似疗效,还具有减压效率更高、手术器械操作灵活、椎间隙处理更彻底、手术时间较短等优点。

Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion(ULIF)and endoscopic transforaminal lumbar interbody fusion(Endo-TLIF)in treatment of lumbar spinal stenosis combined with intervertebral disc herniation.Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation,who were admitted between April 2020 and November 2021 and met the selection criteria,was retrospectively analyzed.Among them,30 patients were treated with ULIF(ULIF group)and 34 patients with Endo-TLIF(Endo-TLIF group).There was no significant difference in baseline data such as gender,age,disease duration,lesion segment,preoperative visual analogue scale(VAS)score of low back pain and leg pain,Oswestry disability index(ODI),spinal canal area,and intervertebral space height between the two groups(P>0.05).The operation time,intraoperative blood loss,hospital stays,and postoperative complications were compared between the two groups,as well as the VAS scores of low back pain and leg pain,ODI,and imaging measurement indicators(spinal canal area,intervertebral bone graft area,intervertebral space height,and degree of intervertebral fusion according to modified Brantigan score).Results Compared with the Endo-TLIF group,the ULIF group had shorter operation time,but had more intraoperative blood loss and longer hospital stays,with significant differences(P<0.05).The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group,and no other complication occurred.There was no significant difference in the incidence of complications between the two groups(P>0.05).All patients in the two groups were followed up 12 months.The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation(P<0.05),and there was no significant difference between different time points after operation(P>0.05).And there was no significant difference between the two groups at each time point after operation(P>0.05).Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area,the change of intervertebral space height,and intervertebral fusion rate at 6 and 12 months(P>0.05).The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group(P<0.05).Conclusion For the patients with lumbar spinal stenosis combined with intervertebral disc herniation,ULIF not only achieves similar effectiveness as Endo-TLIF,but also has advantages such as higher decompression efficiency,flexible surgical instrument operation,more thorough intraoperative intervertebral space management,and shorter operation time.