经皮Kambin三角入路腰椎融合术治疗退行性腰椎滑脱

Percutaneous Kambin's triangle approach lumbar interbody fusion for degenerative lumbar spondylolisthesis

[目的]对比自研配套器械经皮Kambin三角入路腰椎间融合术(percutaneous Kambin triangle approach lumbar interbody fusion, PKLIF)与常规微创经椎间孔腰椎间融合术(minimal invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗退行性腰椎滑脱(degenerative lumbar spondylolisthesis, DLS)的临床疗效。[方法]回顾性分析2023年3月—2024年3月本院收治的32例DLS患者的临床资料。根据术前医患沟通结果,15例采用自研配套器械行PKLIF,另外17例行常规入路MISTLIF。比较两组临床及影像资料。[结果]所有患者均顺利完成手术,无神经损伤及死亡等严重并发症,平均随访时间(6.0±1.8)个月。PKLIF术中出血量[(82.7±9.6) ml vs (165.3±25.3) ml, P<0.001]、下地时间[(1.9±0.7) d vs (3.1±0.6) d, P<0.001]、住院时间[(8.3±2.2) d vs (11.7±2.6) d, P<0.001]、术后1 d腰痛VAS评分[(1.8±0.7) vs (2.9±0.7), P<0.001]、术后2周ODI评分[(31.2±3.0)vs (40.6±5.8), P<0.001]均显著优于MIS-TLIF。但是,PKLIF组透视次数[(17.7±1.7)次vs (5.1±1.0)次, P<0.001]及手术时间[(134.0±12.4) min vs (115.9±13.7) min, P<0.001]显著大于MIS-TLIF组。[结论] PKLIF治疗DLS可以缓解临床症状,同时具有术中出血量少、下地时间早、住院时间短等优势。相比MIS-TLIF,不足之处是术中透视次数多、手术时间长。

[Objective]To compare clinical outcomes of percutaneous Kambin's triangle approach lumbar interbody fusion(PKLIF)versus minimal invasive transforaminal lumbar interbody fusion(MIS-TLIF)for degenerative lumbar spondylolisthesis(DLS).[Methods]Aretrospective study was conducted on 32 patients who had DLS treated surgically in our hospital from March 2023 to March 2024.Accord-ing to preoperative doctor-patient communication,15 patients received PKLIF with self-developed instruments,while other 17 patients re-ceived routine MIS-TLIF.Clinical and imaging data of the two groups were compared.[Results]All patients had the corresponding surgicalprocedures performed successfully without serious complications such as nerve injury and death,and were followed up in a mean of(6.0±1.8)months.The PKLIF group proved significantly superior to the MIS-TLIF group in terms of intraoperative blood loss[(82.7±9.6)ml vs(165.3±25.3)ml,P<0.001],postoperative ambulation time[(1.9±0.7)days vs(3.1±0.6)days,P<0.001],hospital stay[(8.3±2.2)days vs(11.7±2.6)days,P<0.001],back pain VAS score one day postoperatively[(1.8±0.7)vs(2.9±0.7),P<0.001]and ODI score 2 weeks after op-eration[(31.2±3.0)vs(40.6±5.8),P<0.001].However,the PKLIF group was significantly greater than the MIS-TLIF group regarding intra-operative fluoroscopy times[(17.7±1.7)times vs(5.1±1.0)times,P<0.001]and operation time[(134.0±12.4)min vs(115.9±13.7)min,P<0.001].[Conclusion]PKLIF does relieve clinical symptoms of DLS,with the advantages of less intraoperative blood loss,early ambulation,and shortened hospitalization,whereas disadvantages of more intraoperative fluoroscopy times and longer operation time compared with theMIS-TLIF.