内镜、微创和开放式经椎间孔椎体间融合术治疗腰椎退行性疾病的效果比较

Effect comparison of endoscopic,minimally invasive and open transforaminal interbody fusion in the treatment of lumbar degenerative diseases

目的比较经椎间孔内镜腰椎椎间融合术(Endo-LIF)、微创腰椎椎间融合术(MIS-TLIF)和开放腰椎椎间融合术(PLIF)治疗腰椎退行性疾病(LDD)的临床疗效和安全性。方法回顾性分析2013年1月至2023年1月在百色市人民医院因LDD接受经椎间孔腰椎椎间融合术就诊的150例患者临床资料,按手术方式分为Endo-LIF组、MIS-TLIF组、PLIF组三组,每组各50例。比较患者手术时间、透视次数、术中失血量、住院时间、并发症以及术前和术后3个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、椎间隙高度指数、病变节段活动度(ROM)。结果PLIF组的手术时间长于Endo-LIF组和MIS-TLIF组,术中透视次数少于Endo-LIF组和MIS-TLIF组,差异有统计学意义(P<0.05)。Endo-LIF组和MIS-TLIF组的手术时间、术中透视次数比较,差异无统计学意义(P>0.05)。患者术中出血量Endo-LIF组少于MIS-TLIF组及PLIF组,MIS-TLIF组少于PLIF组,差异有统计学意义(P<0.05);患者术后卧床时间和住院时间Endo-LIF组短于MIS-TLIF组及PLIF组,MIS-TLIF组短于PLIF组,差异有统计学意义(P<0.05)。三组患者满意度比较,差异有统计学意义(P<0.05)。Endo-LIF组满意度高于PLIF组,差异有统计学意义(P<0.017)。三组患者术后3个月VAS及ODI评分低于手术前,差异有统计学意义(P<0.01)。三组患者并发症发生率、椎间隙高度指数、ROM比较,差异无统计学意义(P>0.05)。结论Endo-LIF、MIS-TLI、PLIF三种手术方法术后3个月的预后结果相似,PLIF术中透视次数最少,Endo-LIF创伤较小,在降低术中出血,缩短术后卧床时间和住院时间方面优势明显,术后恢复速度较快,适合临床推广。

Objective To compare the clinical efficacy and safety of endoscopic lumbar interbody fusion(Endo-LIF),minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and open lumbar interbody fusion(PLIF)in the treatment of lumbar degenerative diseases(LDD).Methods The clinical data of 150 patients who underwent transforaminal lumbar interbody fusion for LDD in Baise People's Hospital from January 2013 to January 2023 were retrospectively analyzed.According to the surgical method,they were divided into Endo-LIF group,MIS-TLIF group and PLIF group,with 50 cases in each group.Operative time,fluoroscopy times,intraoperative blood loss,length of hospital stay,complications,visual analogue scale(VAS),Oswestry disability index(ODI),vertebral space height index,and range of motion(ROM)were compared between the three groups before and 3 months after surgery.Results The operative time of PLIF group was longer than that of Endo-LIF group and MIS-TLIF group,and the intraoperative fluoroscopy times were less than those of Endo-LIF group and MIS-TLIF group,the differences were statistically significant(P<0.05).There were no significant differences in operation time and intraoperative fluoroscopy times between Endo-LIF group and MIS-TLIF group(P>0.05).Intraoperative blood loss in Endo-LIF group was less than that in MIS-TLIF group and PLIF group,and that in MIS-TLIF group was less than that in PLIF group,the differences were statistically significant(P<0.05).Postoperative bed time and hospital stay in Endo-LIF group were shorter than those in MIS-TLIF group and PLIF group,and MIS-TLIF group was shorter than PLIF group,the differences were statistically significant(P<0.05).The satisfaction of the three groups was compared,the difference was statistically significant(P<0.05).The satisfaction of Endo-LIF group was higher than PLIF group,and the difference was statistically significant(P<0.017).VAS and ODI scores 3 months after operation were lower than those before operation,and the differences were statistically significant(P<0.01).There were no significant differences in complication rate,vertebral space height index and ROM among three groups(P>0.05).Conclusion Endo-LIF,MIS-TLI and PLIF had similar prognosis 3 months after operation.PLIF had the least number of intraoperative fluoroscopy,Endo-LIF had less trauma,and had obvious advantages in reducing intraoperative bleeding,shortening postoperative bed time and hospital stay,and had faster postoperative recovery,which was suitable for clinical promotion.