全可视化单通道内镜下腰椎减压融合术的临床疗效

Clinical efficacy of full-visualization single-channel endoscopic posterior lumbar interbody fusion

目的分析全可视化单通道脊柱内镜下腰椎管减压椎间融合术(PE-PLIF)治疗腰椎退行性疾病的临床疗效,探讨镜下椎管减压及椎间融合技术的应用技巧及意义。方法回顾性选择2021年1月至2022年12月南京医科大学附属淮安第一医院采用PE-PLIF治疗的患者50例,共对56个下腰椎节段进行椎管减压并椎间融合,术中采用镜下监视8 mm环锯去除关节突及椎板,采用可扩张融合器植入技术行椎管减压、椎间融合,辅助经皮椎弓根螺钉内固定。术前及术后1 d、3个月、6个月随访时,运用腰痛及下肢痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、改良MacNab评分系统等进行临床疗效评估。结果术前和术后1 d、3个月、6个月以及末次随访时患者腰痛VAS评分分别为(5.2±1.1)分,(2.2±0.7)分,(1.5±0.6)分,(1.3±0.7)分,(1.0±0.9)分;下肢痛VAS评分分别为(7.2±1.0)分,(2.0±1.0)分,(0.5±0.3)分,(0.3±0.2)分,(0.3±0.2)分。术前和术后3个月、6个月以及末次随访时患者ODI分别为66.3±7.4,16.6±5.0,12.4±3.6,10.7±3.3,术后VAS评分、ODI评分降低,与术前对比差异有统计学意义(P<0.05)。末次随访时按照改良MacNab标准评估临床疗效,优良率为92.0%。结论PE-PLIF能够实现椎管的有效减压,椎间融合率高,具有创伤小、出血少、恢复快等优势;通过优化操作流程,可明显缩短镜下减压及融合操作时间、减少神经根牵拉损伤风险。

Objective To analyze the clinical efficacy of full-visualization single-channel endoscopic lumbar interbody fusion(PE-PLIF)in the treatment of lumbar degenerative diseases,and to explore the application skills and significance of endoscopic spinal canal decompression and interbody fusion.Methods From January 2021 to December 2022,50 patients who underwent PE-PLIF in The Affiliated Huai an No.1 Hospital of Nanjing Medical University were selected retrospectively.A total of 56 lower lumbar segments were treated with spinal canal decompression and interbody fusion.The expandable cage implantation technique was used for spinal canal decompression,intervertebral fusion,and percutaneous pedicle screw internal fixation.The visual analogue scale(VAS)score of low back pain and lower limb pain,Oswestry disability index(ODI),and modified MacNab scoring system were used to evaluate the clinical efficacy before and after operation.Results The VAS scores of low back pain were 5.2±1.1,2.2±0.7,1.5±0.6,1.3±0.7,1.0±0.9 before operation,1 day,3 months,6 months after operation and at the last follow-up,respectively.The VAS scores of lower limb pain were 7.2±1.0,2.0±1.0,0.5±0.3,0.3±0.2,0.3±0.2,respectively.The ODI was 66.3±7.4,16.6±5.0,12.4±3.6 and 10.7±3.3 before operation,3 months,6 months after operation and at the last follow-up,respectively.The VAS score and ODI score decreased after operation,and the differences were statistically significant compared with those before operation(P<0.05).According to the modified MacNab criteria,the rate of excellent and good was 92.0%at last follow-up.Conclusion PE-PLIF can achieve effective decompression of the spinal canal,high rate of interbody fusion,less trauma,less bleeding,rapid recovery and other advantages.By optimizing the operation process,the operation time of arthroscopic decompression and fusion can be significantly shortened,and the risk of nerve root traction injury can be reduced.