单侧双通道内镜与微创通道下经腰椎间融合术治疗腰椎退行性疾病的疗效对比及对疼痛介质的影响

Comparison of Curative Effect between Unilateral Double-channel Endoscope and Minimally Invasive Lumbar Interbody Fusion in the Treatment of Lumbar Degenerative Diseases and its Influence on Pain Medium

目的比较单侧双通道内镜(uNLATERAL BIPORTAL ENDOSCOPIY,UBE)与微创通道(minimally invasive tubular,Mis)下经腰椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病的疗效及对疼痛介质的影响。方法回顾性分析张家港市第一人民医院骨科2020年2月至2023年5月收治的82例腰椎退行性疾病患者,按照治疗方案不同分为Mis-TLIF组(42例)和UBE-TLIF组(40例)。比较两组手术情况、术后并发症发生情况、术后疼痛、功能障碍程度及疼痛介质水平。结果与Mis-TLIF组比较,UBE-TLIF组手术时间稍长,但术中出血量及术后引流量均较少,住院时间较短,差异有统计学意义(P<0.05);两组随访时间对比,差异无统计学意义(P>0.05)。两组疗效优良率对比,差异无统计学意义(P>0.05)。术前,两组VAS评分、ODI评分对比,差异无统计学意义(P>0.05);术后两组VAS评分、ODI评分均较术前改善,且术后1月UBE-TLIF组VAS、ODI评分均低于Mis-TLIF组,差异有统计学意义(P<0.05);术后3个月、6个月及末次随访时,两组VAS、ODI评分对比,差异无统计学意义(P>0.05)。术前,SP、PGE2、β-EP水平对比,差异无统计学意义(P>0.05);术后3 d,UBE-TLIF组SP水平高于Mis-TLIF组,PGE2、β-EP水平均低于Mis-TLIF组,差异有统计学意义(P<0.05)。两组并发症发生率对比,差异无统计学意义(P>0.05)。结论UBE-TILF治疗腰椎退行性疾病可达到与Mis-TLIF相同的临床疗效,还具有术中出血量少、术后住院时间短等优点,近期效果更佳。

Objective:To compare the curative effect of unilateral dual-channel endoscope(UBE)and minimally invasive tubular(Mis)in the treatment of lumbar degenerative diseases and its influence on pain media.Methods:Eighty-two patients with lumbar degenerative diseases admitted to the Department of Orthopaedics of the First People's Hospital of Zhangjiagang City from February 2020 to May 2023 were analyzed retrospectively.They were divided into Mis-TLIF group(42 cases)and UBE-TLIF group(40 cases)according to different treatment schemes.The operation situation,postoperative complications,postoperative pain,degree of dysfunction and pain medium level were compared between the two groups.Results:Compared with Mis-TLIF group,UBE-TLIF group had a slightly longer operation time,but less intraoperative bleeding and postoperative drainage,and shorter hospital stay,with statistical significance(P<0.05).There was no significant difference in the follow-up time between the two groups(P>0.05).There was no significant difference between the two groups(P>0.05).Before operation,there was no significant difference in VAS score and ODI score between the two groups(P>0.05).The VAS and ODI scores of both groups were improved after operation,and the VAS and ODI scores of UBE-TLIF group were lower than those of Mis-TLIF group one month after operation,the difference was statistically significant(P<0.05).At 3 months,6 months and the last follow-up,there was no significant difference in VAS and ODI scores between the two groups(P>0.05).Before operation,the levels of SP,PGE2_2 andβ-EP were not significantly different(P>0.05).Three days after operation,the SP level in UBE-TLIF group was higher than that in Mis-TLIF group,and the PGE2 andβ-EP levels were lower than that in Mis-TLIF group,with statistical significance(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:UBE-TILF can achieve the same clinical effect as Mis-TLIF in the treatment of lumbar degenerative diseases,and it also has the advantages of less intraoperative blood loss and shorter postoperative hospitalization time,and the short-term effect is better.