脊柱内镜辅助下的经椎间孔腰椎椎体间融合术治疗腰椎间盘突出症肥胖患者的临床效果

Clinical Effect of Endoscopic Assisted Transforaminal Lumbar Interbody Fusion for the Treatment of Obese Patients with Lumbar Disc Herniation

【目的】探讨脊柱内镜辅助下的经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎间盘突出症(LDH)肥胖患者的临床效果。【方法】选择2020年2月至2022年5月本院收治的93例LDH肥胖患者,按照手术方法不同分为观察组(接受脊柱内镜辅助下的TLIF治疗,n=47)和对照组(接受传统后路开放手术治疗,n=46)。比较两组手术相关指标、视觉模拟评分法(visual analogue scale,VAS)评分、腰椎功能[日本骨科协会(Japanese Orthopaedic Association,JOA)评分与Oswestry功能障碍指数(Oswestry disability index,ODI)评分]、影像学参数、塌陷率、融合率及并发症发生率。【结果】观察组手术时间长于对照组(P<0.05),总住院时间、术后首次下床时间短于对照组(P<0.05),术中出血量少于对照组(P<0.05)。两组术前、术后1 d、术后12个月的ODI评分、下肢VAS评分、JOA评分、腰部VAS评分比较,差异均无统计学意义(P>0.05)。术后12个月,两组顶椎中心偏移距离、腰椎冠状位Cobb角均低于术前,腰椎矢状位Cobb角均高于术前,差异均有统计学意义(P<0.05),且观察组顶椎中心偏移距离、腰椎冠状位Cobb角、腰椎矢状位Cobb角恢复情况优于对照组(P<0.05)。观察组塌陷率明显低于对照组(P<0.05),融合率高于对照组(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。【结论】与传统后路开放手术相比,脊柱内镜辅助下的TLIF治疗LDH肥胖患者效果更好,影像学参数改善更佳,患者恢复更快,融合器塌陷风险更低,且融合率更高。

【Objective】To investigate the clinical efficacy of transforaminal lumbar interbody fusion(TLIF)assisted by spinal endoscopy in the treatment of obese patients with lumbar disc herniation(LDH).【Methods】A total of 93 obese patients with LDH admitted to our hospital from February 2020 to May 2022 were selected and divided into the observation group(receiving TLIF treatment assisted by spinal endoscopy,n=47)and the control group(receiving traditional posterior open surgery,n=46)according to different surgical methods.The surgical related indicators,visual analog scale(VAS)scores,lumbar spine function[Japanese Orthopaedic Association(JOA)scores and Oswestry Disability Index(ODI)scores],imaging parameters,collapse rate,fusion rate,and incidence of complications were compared between the two groups.【Results】The observation group had a longer surgery time than the control group(P<0.05),shorter total hospital stay and first time out of bed after surgery compared to the control group(P<0.05),and less intraoperative bleeding compared to the control group(P<0.05).There was no statistically significant difference in ODI scores,lower limb VAS scores,JOA scores,and lumbar VAS scores between the two groups before surgery,1 day after surgery,and 12 months after surgery(P>0.05).12 months after surgery,the displacement distance of the top vertebral center and the Cobb angle of the lumbar coronal plane in both groups were lower than before surgery,and the Cobb angle of the lumbar sagittal plane was higher than before surgery,with statistically significant differences(P<0.05).Moreover,the recovery of the displacement distance of the top vertebral center,Cobb angle of the lumbar coronal plane,and Cobb angle of the lumbar sagittal plane in the observation group was better than that in the control group(P<0.05).The collapse rate of the observation group was significantly lower than that of the control group(P<0.05),and the fusion rate was higher than that of the control group(P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P>0.05).【Conclusion】Compared with traditional posterior open surgery,TLIF assisted by spinal endoscopy is more effective in treating LDH obese patients,with better improvement in imaging parameters,faster recovery,lower risk of fusion device collapse,and higher fusion rate.