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单侧双通道内镜下(UBE-TLIF)与微创经椎间孔腰椎融合术(MIS-TLIF)治疗退变性腰椎椎管狭窄症的疗效比较
Comparison of the efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis
投稿时间:2023-06-01  
DOI:10.3969/j.issn.1672-5972.2024.02.007
中文关键词:  单侧双通道内镜  微创  腰椎间融合  单节段腰椎椎管狭窄
英文关键词:Unilateral biportal endoscopy  Minimally invasive  Lumbar interbody fusion  Single-segment lumbar spinal stenosis
基金项目:四川省自然科学基金项目(2023NSFSC1798);成都市技术创新研发项目(2022-YF05-02064-SN;2022-YF05-01900-SN)
作者单位邮编
周毅 成都中医药大学附属医院骨科四川 成都610032 610032
陈日高 成都中医药大学附属医院骨科四川 成都610032 610032
于开凡 成都中医药大学附属医院骨科四川 成都610032 610032
廖子康 成都中医药大学附属医院骨科四川 成都610032 610032
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中文摘要:
      目的 比较单侧双通道内镜下经椎间孔腰椎椎间融合术(unilateral biportal endoscopic transforaminal lumbar interbody fusion, UBE-TLIF)与微创经椎间孔入路腰椎椎间融合术(minimal invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗单节段退行性腰椎椎管狭窄症的疗效。方法 回顾性分析2021年1月至2021年12月成都中医药大学附属医院符合纳入标准的68例单节段退行性腰椎椎管狭窄症患者的临床资料,按手术方式分为UBE-TLIF组(27例)与MIS-TLIF组(41例)。对比两组患者的手术相关指标(手术时间、术中出血量、术后引流量、术后住院天数、并发症发生率等);实验室检查结果[全血C反应蛋白(C-reactive protein, CRP)、血清磷酸肌酸激酶(creatine kinase, CK)]及临床疗效评价[腰痛及下肢疼痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)、改良MacNab标准评价优良率、Brantigan标准评价椎间融合率]等。结果 68例患者均获得随访,随访时间12 ~ 20个月。与MIS-TLIF组相比,UBE-TLIF组患者的手术时间、住院时间更长,但术中出血量、术后引流量更短(P<0.05)。实验室检查方面:术前两组实验室检查差异无统计学意义(P>0.05);术后3 d UBE-TLIF组全血C反应蛋白含量较MIS-TLIF组低(P<0.05);术后1、3 dUBE-TLIF组血清磷酸肌酸激酶水平均低于MIS-TLIF组(P<0.05)。临床疗效评价:术前两组间患者腰痛及下肢疼痛视觉模拟评分及Oswestry功能障碍指数比较,差异无统计学意义(P>0.05),术后各时间点上述评分均较术前显著下降(P<0.05);组间比较发现各组术后3 d、1个月、6个月、12个月的腰痛及下肢疼痛视觉模拟评分,术后3、12个月Oswestry功能障碍指数,末次随访优良率,椎间融合率比较,差异无统计学意义(P>0.05)。并发症方面:UBE-TLIF组无并发症发生,MIS-TLIF组发生并发症2例,包括术后切口感染1例及术后下肢麻木1例,两组间并发症发生率比较,差异无统计学意义(P>0.05)。结论 UBE-TLIF手术方式可达到与MIS-TLIF手术方式相似的术后腰痛疼痛评分、腿疼痛评分、功能障碍指数,且较MIS-TLIF肌肉损伤释放的CK更少、组织出血量更少、术后恢复更快。
英文摘要:
      Objective To compare UBE-TLIF with MIS-TLIF for single-segment degenerative lumbar spinal stenosis.Methods A retrospective analysis was performed of the clinical data of 68 patients with single-segment degenerative lumbar spinal stenosis in this treatment group who met the inclusion criteria from January 2021 to December 2021, including 27 patients in the UBE-TLIF group and 41 patients in the MIS-TLIF group. Surgery-related indexes (operation time, intraoperative bleeding, postoperative drainage, postoperative hospitalization days, complication rate, etc.), laboratory findings (whole blood C-reactive protein, serum phosphocreatine kinase), and evaluation of clinical efficacy (visual analogue scale for low back pain and lower extremity pain, Oswestry dysfunction index, modified MacNab standard for evaluating the rate of excellence, Brantigan criteria for evaluation of intervertebral fusion rate, etc.) were compared between the two groups.Results All 68 cases were followed up for 12 to 20 months. Compared with the MIS-TLIF group, patients in the UBE-TLIF group had longer operation time and hospital stay, and less intraoperative blood loss and postoperative drainage (P<0.05). Laboratory examination: There was no statistically significant difference in laboratory examination between the two groups before operation (P>0.05). CRP was lower in the UBE-TLIF group than in the MIS-TLIF group at 3 d after operation (P<0.05). CK was lower in the UBE-TLIF group than in the MIS-TLIF group at 1 and 3 d after operation (P<0.05). Clinical efficacy evaluation: There was no statistical difference in the patient's VAS of low back pain and lower extremity pain and ODI between the two groups before surgery (P>0.05), and the above scores decreased significantly at all time points after surgery compared with those before surgery (P<0.05); intergroup comparisons revealed no statistically significant differences in the VAS for low back pain and lower extremity pain at 3 d, 1 month, 6 months, and 12 months postoperatively, the ODI at 3 and 12 months postoperatively, the excellent rate at the final follow-up, and the rate of intervertebral fusion (P>0.05). Complications: No complications occurred in the UBE-TLIF group, and 2 cases of complications occurred in the MIS-TLIF group, including 1 case of postoperative incision infection and 1 case of postoperative lower limb numbness, and there was no statistically significant difference in the rate of complications between the two groups (P>0.05).Conclusion UBE-TLIF achieves similar postoperative low back pain scores, leg pain scores, and dysfunction indexes as MIS-TLIF, with less CK release from muscle damage, less tissue bleeding, and faster postoperative recovery than MIS-TLIF.
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