微创经椎间孔腰椎椎间融合术与内镜下腰椎椎间融合术治疗腰椎退行性疾病的临床疗效

Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion and endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases

目的比较微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与内镜下腰椎椎间融合术(endoscopic lumbar interbody fusion,Endo-LIF)对腰椎退行性疾病的疗效及安全性。方法对宁国市人民医院和杭州市第一人民医院2019年1月至2021年7月诊断为腰椎退行性变的115例患者的资料进行回顾性分析,其中MIS-TLIF组54例,Endo-LIF组61例。记录和比较两组患者术前和术后1周、3个月、1年随访的腰痛视觉模拟评分(VAS)以及Oswestry功能障碍指数(Oswestry dability index,ODI),采用改良MacNab标准评价疗效等。结果Endo-LIF组的手术时间长于MIS-TLIF组[(155.61±8.50)min vs(128.00±8.40)min];但Endo-LIF组的术中出血量[(60.39±5.54)mL vs(129.39±8.59)mL]和住院时间[(3.91±0.74)d vs(4.96±1.57)d]少于MIS-TLIF组,差异有统计学意义(P<0.05)。两组术后随访的各时间点VAS和ODI评分均较术前显著降低(P<0.05)。且术后3个月、1年Endo-LIF组的VAS评分低于MIS-TLIF组(P<0.05)。术后1年MacNab疗效评估显示,MIS-TLIF组和Endo-LIF组的优良率差异无统计学意义(96.3%vs 96.7%,χ^(2)=0.149,P>0.05)。结论MIS-TLIF和Endo-LIF的临床疗效与手术安全性在中短期无明显差别,Endo-LIF组对周围组织损伤更小、术中出血量更少、术后腰痛少,从长远来看更利于患者的恢复,但Endo-LIF适应证相对有限,学习曲线较长,术者需要严格选择适应证。

Objective To compare the safety and clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF)for lumbar degenerative diseases.Methods A retrospective analysis was conducted on the data of 115 patients diagnosed with lumbar degenerative disease at Ningguo People's Hospital and Hangzhou First People's Hospital from January 2019 to July 2021,including 54 cases in the MIS-TLIF group and 61 cases in the Endo-LIF group.The clinical outcomes were compared before operation,and at 1 week,1 month,3 months and 1-year post-operation,including visual analogue scale(VAS),Oswestry disability index scores(ODI)and modified MacNab criteria.Results The surgical time in the Endo-LIF group was longer than that in the MIS-TLIF group[(155.61±8.50)min vs(128.00±8.40)min];however,the surgical bleeding volume[(60.39±5.54)mL vs(129.39±8.59)mL]and hospital stay[(3.91±0.74)d vs(4.96±1.57)d]in the Endo-LIF group were lower than those in the MIS-TLIF group,and the differences were statistically significant(P<0.05).The VAS score of low back pain and ODI score in the two groups at each time point after operation were significantly lower than those before operation(P<0.05).At 3 month,1 year post-operation,the VAS score of the Endo-LIF group was lower than that of the MIS-TLIF group(P<0.05).The 1 year post-operative MacNab efficacy evaluation showed no statistically significant difference in the excellent and good rates between the MIS-TLIF group and the Endo-LIF group(96.3%vs 96.7%,χ^(2)=0.149,P>0.05).Conclusion There was no significant difference in medium-short term surgical outcomes between MIS-TLIF and Endo-LIF.Endo-LIF group has less damage to surrounding tissues,less intraoperative blood loss,and less low-back pain,which is more conducive to the recovery of patients in the long run.However,the indications of Endo-LIF are relatively limited,and the learning curve of Endo-LIF is deep,surgeons need to select indications strictly.