| 张青山,张亚宁,常建军.内窥镜下腰椎椎间融合术与微创经椎间孔入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症的疗效及安全性对比[J].脊柱外科杂志,2024,22(4):239-245. |
内窥镜下腰椎椎间融合术与微创经椎间孔入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症的疗效及安全性对比  点此下载全文 (Fulltext) |
| 张青山 张亚宁 常建军 |
| 临汾市人民医院骨科, 临汾 041000 |
| 基金项目：临汾市人民医院2023年度第一批院级课题立项项目（T2023012） |
| DOI：10.3969/j.issn.1672-2957.2024.04.005 |
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| 摘要： |
| 目的 探讨脊柱内窥镜下腰椎椎间融合术（Endo-LIF）与微创经椎间孔入路腰椎椎间融合术（MIS-TLIF）治疗退行性腰椎椎管狭窄症（DLSS）的疗效与安全性。 方法 回顾性分析2020年7月—2022年12月收治的114例DLSS患者临床资料，根据手术方式分为Endo-LIF组和MIS-TLIF组，采用倾向性评分进行1∶1匹配，剔除不匹配的患者，每组53例。记录并比较2组手术时间、术中出血量、术后引流量、术后下床时间、住院时间、融合情况及并发症发生情况。于术前和术后1 d、3 d检测肾上腺素E、皮质醇、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平等创伤应激指标。于术前、术后7 d、术后3个月采用疼痛视觉模拟量表（VAS）评分评估腰痛及下肢痛程度，采用Oswestry功能障碍指数（ODI）和日本骨科学会（JOA）评分评估腰椎功能；在全脊柱X线片上测量椎间隙高度、腰椎前凸角、硬膜囊横截面积、椎间孔面积。 结果 所有手术顺利完成，患者随访12个月。Endo-LIF组术中出血量、术后引流量少于MIS-TLIF组，手术时间、术后下床时间、住院时间短于MIS-TLIF组，差异均有统计学意义（P < 0.05）。2组术后1 d、3 d血清前列腺素E、皮质醇、CRP、TNF-α水平较术前升高，且Endo-LIF组术后1 d、3 d各创伤应激指标水平低于MIS-TLIF组，差异均有统计学意义（P < 0.05）。2组术后7 d、术后3个月的腰痛和下肢痛VAS评分、ODI、JOA评分较术前明显改善，且Endo-LIF组较MIS-TLIF组改善更明显，差异均有统计学意义（P < 0.05）。2组术后7 d、术后3个月椎间隙高度、腰椎前凸角、硬膜囊横截面积、椎间孔面积较术前改善，差异均有统计学意义（P < 0.05）；组间差异均无统计学意义（P > 0.05）。Endo-LIF组并发症发生率低于MIS-TLIF组，差异有统计学意义（P < 0.05）。2组术后均100%融合。 结论 与MIS-TLIF相比，Endo-LIF治疗DLSS能缩短手术时间，减少术中出血量和术后引流量，加速康复进程，减轻创伤应激及疼痛程度，促进腰椎功能恢复，且并发症发生率较低，具有明显优势，值得临床推广。 |
| 关键词：腰椎 椎管狭窄 脊柱融合术 外科手术，微创性 |
| Comparison in efficacy and safety between endoscopic lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in treatment of degenerative lumbar spinal stenosis Fulltext |
| Zhang Qingshan Zhang Yaning Chang Jianjun |
| Department of Orthopaedics, Linfen People's Hospital, Linfen 041000, Shanxi, China |
| Fund Project: |
| Abstract: |
| Objective To evaluate the efficacy and safety of endoscopic lumbar interbody fusion（Endo-LIF） and minimally invasive transforaminal lumbar interbody fusion（MIS-TLIF） in the treatment of degenerative lumbar spinal stenosis（DLSS）. Methods A total of 114 patients with DLSS from July 2020 to December 2022 were retrospectively analyzed and divided into Endo-LIF group and MIS-TLIF group according to surgical methods using propensity score for 1∶1 matching，excluding mismatched patients，with 53 patients in each group. The operation time，intraoperative blood loss，postoperative drainage volume，postoperative time getting out of bed，hospital stay，fusion and complications of the 2 groups were recorded and compared. The levels of epinephrine E，cortisol，C-reactive protein（CRP），tumor necrosis factor-α（TNF-α） were detected before and 1 d and 3 d after surgery. The visual analogue scale（VAS） score was used to evaluate the intensity of low back pain and leg pain before and 7 d，3 months after surgery. The Oswestry disability index（ODI） and Japanese Orthopaedic Association（JOA） score were used to evaluate the lumbar function. The intervertebral height，lumbar lordosis angle，dural sac cross-sectional area and foramen area were measured on whole spine roentgenograph. Results All the operations were successfully completed and the patients were followed up for 12 months. The intraoperative blood loss and postoperative drainage volume in Endo-LIF group were lower than those in MIS-TLIF group，and the operation time，postoperative time getting out of bed and hospital stay were shorter than those in MIS-TLIF group，all with a statistical significance（P < 0.05）. The levels of prostaglandin E，cortisol，CRP and TNF-α in the 2 groups at postoperative 1 and 3 d were higher than those before surgery，and the above traumatic stress indexes at postoperative 1 and 3 d in Endo-LIF group were lower than those in MIS-TLIF group，all with a statistical significance（P < 0.05）. The VAS score of lower back pain and leg pain，ODI and JOA score in the 2 groups at postoperative 7 d and 3 months were significantly improved compared with those before surgery，and the improvements in Endo-LIF group were more obvious than those in MIS-TLIF group，all with a statistical significance（P < 0.05）. The intervertebral height，lumbar lordosis angle，dural sac cross-sectional area and foraminal area in the 2 groups at postoperative 7 d and 3 months were improved compared with those before surgery，all with a statistical significance（P < 0.05）. However，there was no statistical significance in the above indexes between the 2 groups（P > 0.05）. The incidence of complications in Endo-LIF group was lower than that in MIS-TLIF group，and the difference was statistically significant（P < 0.05）. Both groups achieved 100% fusion after surgery. Conclusion Compared with MIS-TLIF，Endo-LIF in the treatment of DLSS can shorten the operation time，reduce the amount of intraoperative blood loss and postoperative drainage volume，accelerate the rehabilitation process，reduce the intensity of traumatic stress and pain，promote the recovery of lumbar function，and with a lower incidence of complications，thus having obvious advantages and being worthy of clinical promotion. |
| Keywords:Lumbar vertebrae Spinal stenosis Spine fusion Surgical procedures,minimally invasive |
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