单侧双通道内镜辅助下后路腰椎椎间融合术与传统后腰椎融合术的临床疗效比较

Comparison of clinical efficacy between unilateral biportal endoscopic associated posterior lumbar interbody fusion with traditional posterior lumbar fusion

目的 比较单侧双通道内镜下腰椎融合术(unilateral biportal endoscopic lumbar interbody fusion, ULIF)和传统开放式腰椎间融合术(posterior lumbar interbody fusion, PLIF)治疗腰椎退行性疾病的临床疗效。方法 回顾性分析2021年1月至2022年12月期间在河南省洛阳正骨医院接受腰椎融合术的125例患者。根据手术方式分为ULIF组(54例)和PLIF组(71例),比较两组的基本数据和手术相关结果(手术时间、术中出血量和术后住院时间)。比较两组患者手术前后的临床状况:腰部和腿部视觉模拟量表(visual analog scale, VAS)评分和Oswestry残疾指数(Oswestry disability index, ODI)。对两组患者手术前后的临床实验室指标进行比较:包括C反应蛋白(C-reactive protein, CRP)、肌酸激酶(creatine kinase, CPK)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、白细胞介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor, TNF-α)和并发症出现的比率。结果 所有患者随访时间为12~24个月,平均随访时间为(18.12±3.46)个月。ULIF组的术中出血量和术后住院时间均少于PLIF组,但手术时间长于PLIF组(P<0.05)。ULIF组患者术后1、3个月腰痛VAS评分,术后1个月腿痛VAS评分及术后1个月ODI评分均优于PLIF组(P<0.05)。两组在6个月时的融合率比较,差异无统计学意义(P>0.05)。术后PLIF组的CRP、CPK、ESR、IL-6和TNF-α水平均显著高于ULIF组(P<0.05)。结论 ULIF和PLIF均为有效的腰椎间融合术。然而,与PLIF相比,ULIF引起的出血更少,炎症反应减少,组织损伤减少,术后恢复更快,在减轻手术过程中损伤的同时有效缓解早期的腰腿部疼痛症状。

Objective To evaluate and compare the clinical outcomes of unilateral biportal endoscopic lumbar interbody fusion(ULIF)with those of traditional posterior lumbar interbody fusion(PLIF)in the treatment of lumbar degenerative disease.Methods Retrospective analysis of 125 patients who underwent lumbar fusion surgery in Luoyang Orthopedic-Traumatological Hospital of Henan Province from January 2021 to December 2022.They were divided into ULIF group(n=54)and PLIF group(n=71)according to the surgical method,and compared the basic data and operation-related outcomes(mean operation time,intraoperative blood loss,and postoperative hospital stay)between the two groups.The pre-and post-operative clinical conditions of the two groups were compared,including visual analogue scale(VAS)and Oswestry disability index(ODI).The pre-and post-operative clinical laboratory indicators were compared between the two groups,including C-reactive protein(CRP),creatine kinase(CPK),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),tumour necrosis factor-α(TNF-α),and the incidence of complications.Results All patients were followed up for 12-24 months,with an average follow-up time of(18.12±3.46)months.The intraoperative blood loss and postoperative hospital stay were lower in the ULIF group than that in the PLIF group.However,the operation time was longer in the ULIF group than that in the PLIF group(P<0.05).The VAS back pain score at 1 month and 3 months after surgery,the VAS leg pain score at 1 month after surgery,and the ODI score at 1 month after surgery in the ULIF group were better than those in the PLIF group(P<0.05),and there was no significant difference in fusion rate between the two groups at 6 months.The levels of CRP,CPK,ESR,IL-6 and TNF-αin the postoperative PLIF group were significantly higher than those in the ULIF group(P<0.05).Conclusion Both ULIF and PLIF are effective surgical techniques for lumbar interbody fusion.However,compared with PLIF,ULIF causes less bleeding,less inflammatory response,less tissue damage and faster postoperative recovery.It effectively alleviates early symptoms of low back and leg pain while reducing intraoperative morbidity.