腰椎滑脱内镜与通道经椎间孔椎体间融合比较

Endoscopic lumbar fusion versus counterpart with tubular retractors for lumbar spondylolisthesis

[目的]比较单侧双通道脊柱内镜下腰椎椎间融合术(unilateral biportal endoscopy lumbar interbody fusion,UBE-LIF)与微创经椎间孔入路腰椎椎间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)治疗Ⅱ~Ⅲ度腰椎滑脱症的效果。[方法]2019年1月—2022年6月本院收治因Ⅱ~Ⅲ度腰椎滑脱症接受手术治疗的249例患者,按随机数字表法将患者分两组,132例采用UBE-LIF(UBE组),另外117采用MIS-TLIF(MIS组),比较两组围手术期、随访及影像资料。[结果]两组病例均顺利完成手术,未发生严重并发症。UBE组术中失血量[(112.2±20.5)ml vs(132.9±25.8)ml,P<0.001]、术中透视次数[(3.9±1.3)次vs(4.6±1.5)次,P<0.001]、下地行走时间[(1.6±0.5)d vs(1.9±0.3)d,P<0.001]均显著优于MIS组。随访时间平均(15.0±3.0)个月,UBE组恢复完全负重活动时间[(65.5±10.2)d vs(68.9±11.6)d,P=0.015]显著早于MIS组。随术后时间推移,两组VAS、ODI、JOA评分均显著改善(P<0.05),术后3个月,UBE组VAS[(2.4±0.4)vs(2.7±0.6),P<0.001]、ODI[(29.2±6.7)vs(33.8±5.8),P<0.001]、JOA评分[(20.3±3.7)vs(18.6±4.2),P<0.001]均显著优于MIS组。影像方面,末次随访时两组滑脱程度、椎间隙高度、LL、局部Cobb角均显著改善(P<0.05),相应时间点,两组上述影像指标的差异均无统计学意义(P>0.05)。[结论]Ⅱ~Ⅲ度腰椎滑脱症采用UBE-LIF与MIS-TLIF治疗效果相似,但UBE-LIF在减少手术创伤及改善近期腰椎功能方面优势明显。

[Objective]To compare the clinical outcomes of unilateral biportal endoscopy lumbar interbody fusion(UBE-LIF),versus minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)for degreeⅡ~Ⅲlumbar spondylolisthesis.[Methods]From January 2019 to June 2022,a total of 249 patients who received surgical treatment for degreeⅡ~Ⅲspondylolisthesis were included in this study,and were divided into two groups according to random number table method.Of them,132 patients received UBE-LIF(the UBE group),while other 117 received MIS-TLIF(the MIS group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]The operation was successfully completed in both groups without serious complications.The UBE group proved significantly superior to the MIS group in terms of intraoperative blood loss[(112.2±20.5)ml vs(132.9±25.8)ml,P<0.001],intraoperative fluoroscopy times[(3.9±1.3)time vs(4.6±1.5)times,P<0.001]and walking time after operation[(1.6±0.5)days vs(1.9±0.3)days,P<0.001].The average follow-up time was of(15.0±3.0)months,and the UBE cohort resumed full weight-bearing activity significantly earlier than the MIS[(65.5±10.2)days vs(68.9±11.6)days,P=0.015].The VAS,ODI and JOA scores in both groups were significantly improved with the time after surgery(P<0.05).The UBE group was significantly better than the MIS group in terms of VAS[(2.4±0.4)vs(2.7±0.6),P<0.001],ODI[(29.2±6.7)vs(33.8±5.8),P<0.001],JOA score[(20.3±3.7)vs(18.6±4.2),P<0.001]3 months after surgery.Radiographically,the extent of slippage,intervertebral height,lumbar lordosis,and local Cobb angle significantly improved in both groups at the last follow-up compared with those preoperatively(P<0.05),whereas which was not statistically significant between the two groups at any time points accordingly(P>0.05).[Conclusion]UBE-LIF achieves clinical consequence similar to MIS-TLIF for degreeⅡ~Ⅲlumbar spondylolisthesis.However,the UBELIF has obvious advantages in reducing surgical trauma and improving short-term lumbar function over the MIS-TLIF.