Endo-PLIF治疗腰椎退行性疾病的临床效果
Clinical effect of endoscopic posterior lumbar interbody fusion in treatment of lumbar degenerative diseases
双鸥 1蔡子军 1张光远 1廖龙腾 1杨小政 1汪文玉1
作者信息
- 1. 上饶市人民医院(南昌大学附属上饶医院)骨科,江西上饶 334000
- 折叠
摘要
目的 评价在全脊柱内镜下经椎板间隙入路腰椎减压椎间融合内固定术(Endo-PLIF)治疗退变性腰椎疾病的临床效果.方法 2022年1月—2023年1月,上饶市人民医院共择期手术治疗退行性腰椎疾病病人94例,对其临床资料进行回顾性分析.依据手术类型分为Endo-PLIF组35例、经椎间孔入路腰椎椎间融合术(MIS-TLIF)组28例和椎间盘镜辅助下经椎间孔椎间融合术(MED-TLIF)组31例.比较3组病人手术时间、术中出血量、住院时间、改良Oswestry功能障碍指数问卷表(ODI)评分、疼痛视觉模拟评分、腰椎局部后凸角以及术后并发症等临床疗效评价指标.结果 各组病人术中出血量、住院时间和手术时间等指标比较,差异均有统计学意义(F=5.735～164.274,P＜0.05);其中Endo-PLIF组术中出血量和住院时间均少于MED-TLIF组和MIS-TLIF组(P＜0.05),但其手术时间均多于MED-TLIF组和MIS-TLIF组(P＜0.05),而MED-TLIF组术中出血量少于MIS-TLIF组(P＜0.05).3组术前ODI和疼痛视觉模拟评分差异无显著性(P＞0.05);3组术后1及6月两评分均显著低于术前(F=88.493～636.184,P＜0.05),且Endo-PLIF组术后两评分均显著低于MED-TLIF组和MIS-TLIF 组(F=9.443～59.883,P＜0.05),但 MIS-TLIF 组术后 6 月的 ODI 评分显著高于 MED-TLIF 组(P＜0.05).3组术后6月的腰椎局部后凸角度均显著低于术前(F=12.504～14.584,P＜0.05),但两两比较差异无统计学意义(P＞0.05).3组术后并发症发生率比较,差异无显著意义(P＞0.05).结论 Endo-PLIF手术视野更稳定,能更好地保护脊柱结构,减少术中出血量与住院时间,降低功能障碍及术后疼痛程度,提高手术疗效,促进术后康复,值得临床推广应用.
Abstract
Objective To investigate the clinical effect of endoscopic posterior lumbar interbody fusion(Endo-PLIF)in the treatment of lumbar degenerative diseases under total spinal endoscopy.Methods A retrospective analysis was performed for the clinical data of 94 patients with degenerative lumbar diseases who underwent elective surgery in Shangrao People's Hospital from January 2022 to January 2023.According to the surgical procedure,the patients were divided into Endo-PLIF group with 35 pa-tients,minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)group with 28 patients,and microendoscopic trans-foraminal lumbar interbody fusion(MED-TLIF)group with 31 patients.The three groups were compared in terms of time of ope-ration,intraoperative blood loss,length of hospital stay,modified Oswestry Disability Index(ODI)score,Visual Analogue Scale(VAS)pain score,local lumbar kyphosis angle,and postoperative complications.Results There were significant differences be-tween the three groups in intraoperative blood loss,length of hospital stay,and time of operation(F=5.735-164.274,P＜0.05),and compared with the MED-TLIF group and the MIS-TLIF group,the Endo-PLIF group had a significantly lower intraoperative blood loss and a significantly shorter length of hospital stay(P＜0.05),as well as a significantly longer time of operation(P＜0.05),while the MED-TLIF group had a significantly lower intraoperative blood loss than the MIS-TLIF group(P＜0.05).There were no significant differences in ODI score and VAS pain score between the three groups before surgery(P＞0.05).All three groups had significant reductions in ODI score and VAS pain score at 1 and 6 months after surgery(F=88.493-636.184,P＜0.05),and the Endo-PLIF group had significantly lower scores than the MED-TLIF group and the MIS-TLIF group(F=9.443-59.883,P＜0.05);the MIS-TLIF group had a significantly higher ODI score than the MED-TLIF group at 6 months after surgery(P＜0.05).All three groups had a significant reduction in local lum-bar kyphosis angle at 6 months after surgery(F=12.504-14.584,P＜0.05),but there was no significant different between any two groups(P＞0.05).There was no significant difference in the inci-dence rate of postoperative complications between the three groups(P＞0.05).Conclusion Endo-PLIF has a more stable surgi-cal field of view and can better protect spinal structure,reduce intraoperative blood loss and length of hospital stay,alleviate dys-function and postoperative pain,improve surgical efficacy,and promote postoperative rehabilitation,and therefore,it holds pro-mise for clinical application.
关键词
腰腿痛/椎间盘退行性变/椎管狭窄/脊椎滑脱/内窥镜检查/脊柱融合术/治疗结果Key words
lumbago leg pain/intervertebral disc degeneration/spinal stenosis/spondylolysis/endoscopy/spinal fusion/treatment outcome引用本文复制引用
基金项目
江西省卫生健康委员会科技计划项目(2021-40934)
上饶市科学技术局基础应用研究项目(2023AB007)
出版年
2024
国家科技期刊平台
NSTL
万方数据