目的:在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法:使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万...目的:在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法:使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据(WANFANG)、维普资讯(VIP)进行检索,选取2010年1月至2023年12月发表的,ULIF与MIS-TLIF治疗腰椎管狭窄症疗效比较的临床对照研究,由两名评价员独立提取资料,利用纽卡斯尔–渥太华量表(NOS)对纳入文献质量进行评价。观察治疗前后,ULIF组与MIS-TLIF组的主要疗效指标(手术时间、术中失血量、术后住院天数、手术节段椎间隙高度、血清肌酸激酶(CK)、血清C反应蛋白(CRP)、Bridewell椎间融合率、腰痛VAS评分、腿痛VAS评分、Oswestry功能障碍指数(ODI)、术后优良率、术后并发症)并对符合纳入标准的研究采用RevMan 5.4软件进行Meta分析。结果:共纳入1篇前瞻性研究和8篇回顾性研究,分为ULIF组(327例)和MIS-TLIF组(338例)。Meta分析结果显示:与ULIF组相比,MIS-TLIF组手术时间更短,术后第1天MIS-TLIF组CK较ULIF组高。ULIF组住院时间更短,术前椎间隙高度ULIF组较低,ULIF组术后第3个月腰痛VAS评分较低,ULIF组术后第1个月ODI较低。其余各时间点两组术中失血量、腰腿痛VAS评分、ODI、CK、CRP、椎间隙高度、椎间融合率、术后优良率、术后并发症比较均无统计学意义。结论:MIS-TLIF较ULIF手术时间更短,但ULIF较MIS-TLIF术中对组织破坏更少,术后住院时间更短,短期内腰腿功能恢复更具优势。Objective: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis (LSS). Methods: A computer-based search was conducted on domestic and international databases including PubMed, Medline, Chinese Biomedical Literature Database (CBM), CNKI, WANFANG, and VIP. Clinical controlled studies published between January 2010 and December 2023 comparing the efficacy of ULIF and MIS-TLIF for LSS were selected. Two evaluators independently extracted data and assessed the quality of included literature using the Newcastle-Ottawa Scale (NOS). The primary efficacy indicators (surgical time, intraoperative blood loss, postoperative hospital stay, intervertebral disc height, serum creatine kinase (CK), serum C-reactive protein (CRP), Bridewell interbody fusion rate, VAS scores for back pain and leg pain, Oswestry Disability Index (ODI), postoperative success rate, and postoperative complications) were observed before and after treatment in both groups. A Meta-analysis was performed using RevMan 5.4 software for studies that met the inclusion criteria. Results: A total of 1 prospective study and 8 retrospective studies were included, comprising 327 cases in the ULIF group and 338 cases in the MIS-TLIF group. Meta-analysis results indicated that compared to the ULIF group, the MIS-TLIF group had shorter surgical times and higher CK levels on the first postoperative day. The ULIF group had shorter hospital stays, lower preoperative disc heights, lower VAS scores for back pain at 3 months postoperatively, and lower ODI scores at 1 month postoperatively. No statistically significant differences were found between the two groups for intraoperative blood loss, VAS scores for back and leg pain, ODI, CK, CRP, intervertebral disc height, fusion rates, postoperative success rates, or postoperative complications. Conclusion: MIS-TLIF has a shorter surgical time compared to ULIF, but ULIF results in less tissue damage, shorter hospital stays, and greater advantages in short-term recovery of lumbar and leg function.展开更多
文摘目的分析经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病术后引流量增加的危险因素。方法选取2020-01/2022-12月因腰椎退行性疾病在作者医院就诊、接受经TLIF且术后引流量数据记载详细的65例患者进行回顾性研究。根据总引流量进行分组,分为引流量正常组(n=32)与引流量增加组(n=33)。比较两组患者的一般资料,通过单因素分析和多因素Logistic回归分析确定两组患者TLIF后引流量增加的危险因素,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析相关危险因素的预测价值。结果引流量增加组患者的年龄、并发症的比例、手术时间、失血量、术前D-二聚体水平、术后第1天引流量均明显大于引流量正常组,而术前血红蛋白、术后白蛋白、术前白细胞计数和术后血小板计数明显低于引流量正常组,差异具有统计学意义(P均<0.05)。Logistic回归分析显示,术中失血量和术后第1天引流量是TLIF术后引流量增加的独立危险因素(P<0.05)。ROC曲线分析结果显示,术前血红蛋白、失血量、术后第1天引流量联合预测模型的曲线下面积(area under the curve,AUC)为0.937,灵敏度为0.818,特异度为0.906,临界值为0.59,联合模型预测腰椎退行性疾病患者TLIF后引流量增加的AUC高于任何单一因素。结论术中失血量、术后第1天引流量是TLIF术后引流量增加的独立危险因素,术前血红蛋白可能是引流量增加的保护因素。联合失血量、术后第1天引流量和术前血红蛋白的回归模型对腰椎退行性疾病患者TLIF后引流量增加的预测价值较高。
文摘目的:在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法:使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据(WANFANG)、维普资讯(VIP)进行检索,选取2010年1月至2023年12月发表的,ULIF与MIS-TLIF治疗腰椎管狭窄症疗效比较的临床对照研究,由两名评价员独立提取资料,利用纽卡斯尔–渥太华量表(NOS)对纳入文献质量进行评价。观察治疗前后,ULIF组与MIS-TLIF组的主要疗效指标(手术时间、术中失血量、术后住院天数、手术节段椎间隙高度、血清肌酸激酶(CK)、血清C反应蛋白(CRP)、Bridewell椎间融合率、腰痛VAS评分、腿痛VAS评分、Oswestry功能障碍指数(ODI)、术后优良率、术后并发症)并对符合纳入标准的研究采用RevMan 5.4软件进行Meta分析。结果:共纳入1篇前瞻性研究和8篇回顾性研究,分为ULIF组(327例)和MIS-TLIF组(338例)。Meta分析结果显示:与ULIF组相比,MIS-TLIF组手术时间更短,术后第1天MIS-TLIF组CK较ULIF组高。ULIF组住院时间更短,术前椎间隙高度ULIF组较低,ULIF组术后第3个月腰痛VAS评分较低,ULIF组术后第1个月ODI较低。其余各时间点两组术中失血量、腰腿痛VAS评分、ODI、CK、CRP、椎间隙高度、椎间融合率、术后优良率、术后并发症比较均无统计学意义。结论:MIS-TLIF较ULIF手术时间更短,但ULIF较MIS-TLIF术中对组织破坏更少,术后住院时间更短,短期内腰腿功能恢复更具优势。Objective: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis (LSS). Methods: A computer-based search was conducted on domestic and international databases including PubMed, Medline, Chinese Biomedical Literature Database (CBM), CNKI, WANFANG, and VIP. Clinical controlled studies published between January 2010 and December 2023 comparing the efficacy of ULIF and MIS-TLIF for LSS were selected. Two evaluators independently extracted data and assessed the quality of included literature using the Newcastle-Ottawa Scale (NOS). The primary efficacy indicators (surgical time, intraoperative blood loss, postoperative hospital stay, intervertebral disc height, serum creatine kinase (CK), serum C-reactive protein (CRP), Bridewell interbody fusion rate, VAS scores for back pain and leg pain, Oswestry Disability Index (ODI), postoperative success rate, and postoperative complications) were observed before and after treatment in both groups. A Meta-analysis was performed using RevMan 5.4 software for studies that met the inclusion criteria. Results: A total of 1 prospective study and 8 retrospective studies were included, comprising 327 cases in the ULIF group and 338 cases in the MIS-TLIF group. Meta-analysis results indicated that compared to the ULIF group, the MIS-TLIF group had shorter surgical times and higher CK levels on the first postoperative day. The ULIF group had shorter hospital stays, lower preoperative disc heights, lower VAS scores for back pain at 3 months postoperatively, and lower ODI scores at 1 month postoperatively. No statistically significant differences were found between the two groups for intraoperative blood loss, VAS scores for back and leg pain, ODI, CK, CRP, intervertebral disc height, fusion rates, postoperative success rates, or postoperative complications. Conclusion: MIS-TLIF has a shorter surgical time compared to ULIF, but ULIF results in less tissue damage, shorter hospital stays, and greater advantages in short-term recovery of lumbar and leg function.
