内镜与小切口经椎间孔腰椎间融合翻修术比较
Comparison of endoscopic versus small-incision transforaminal lumbar interbody fusion revisions
蒙觉威 1陈勇喜 2覃海飚 2郭圣挥 1覃忠设 1刘科第 1崔善林 1范俊鸿 1李品元3
作者信息
- 1. 广西中医药大学,广西南宁 530200
- 2. 广西中医药大学第一附属医院,广西南宁 530003
- 3. 横州市中医医院;广西南宁 530399
- 折叠
摘要
[目的]比较内镜下经椎间孔入路腰椎椎间融合术(endoscopic transforaminal lumbar interbody fusion,Endo-TLIF)与微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)单节段腰椎翻修术的疗效.[方法]回顾性分析2016年10月-2022年1月在本院脊柱外科接受单节段腰椎翻修手术60例患者的临床资料,根据医患沟通结果,30例采用行Endo-TLIF术翻修(内镜组),30例采用MIS-TLIF术翻修(小切口组),比较两组围手术期、随访及影像学资料.[结果]内镜组手术时间[(163.0±11.4)min vs(187.8±10.9)min,P＜0.001]、切口总长度[(6.0±0.2)cm vs(7.2±0.8)cm,P＜0.001]、术中出血量[(88.3±10.5)ml vs(110.2±11.7)ml,P＜0.001]、术中透视次数[6.0±1.5)次 vs(8.0±1.3)次,P＜0.001]、下地行走时间[(3.1±1.8)d vs(5.7±2.1)d,P＜0.001]、住院天数[(4.9±1.5)d vs(7.9±2.6)d,P＜0.001]均显著优于小切口组.两组术中并发症发生率的差异无统计学意义(P＞0.05).两组患者均获12个月以上随访,内镜组恢复完全负重活动时间显著早于小切口组[(28.2±3.9)d vs(35.7±6.5)d,P＜0.001].随时间推移,两组腰痛、腿痛VAS和ODI评分均显著减少(P＜0.05).术后3个月,内镜组腰痛 VAS[(2.9±1.3)vs(4.1±1.7),P=0.006]、腿痛 VAS[(2.4±1.2)vs(3.2±1.3),P=0.026]和 ODI 评分[(10.7±3.1)vs(14.1±5.1),P=0.003]均显著优于小切口组.影像方面,术后两组椎管面积、椎间隙高度明显增加(P＜0.05),相应时间点,两组间上述影像指标及融合分级的差异均无统计学意义(P＞0.05).[结论]对于单节段腰椎翻修,Endo-TLIF能获得与MIS-TLIF具有相同的治疗效果,并且,Endo-TLIF创伤更小、并发症更少、术后恢复更快、安全性更高.
Abstract
[Objective]To compare the clinical outcomes of endoscopic transforaminal lumbar interbody fusion(Endo-TLIF)versus minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for single-segment lumbar revision.[Methods]A retrospective study was conducted on 60 patients who underwent single-level lumbar revision surgery in the spinal surgery department of our hospital from October 2016 to January 2022.According to doctor-patient communication,30 patients underwent Endo-TLIF revision,whereas other 30 patients underwent MIS-TLIF revision.The perioperative period,follow-up and imaging data of the two groups were compared.[Re-sults]The endo-TLIF group proved significantly superior to the MIS-TLIF group in terms of operation time[(163.0±11.4)min vs(187.8±10.9)min,P＜0.001],total incision length[(6.0±0.2)cm vs(7.2±0.8)cm,P＜0.001],blood loss[(88.3±10.5)ml vs(110.2±11.7)ml,P＜0.001],intraoperative fluoroscopy times[(6.0±1.5)times vs(8.0±1.3)times,P＜0.001],ambulation time[(3.1±1.8)days vs(5.7±2.1)days,P＜0.001],hospitalization days[(4.9±1.5)days vs(7.9±2.6)days,P＜0.001],however,there was no significant difference in the incidence of in-traoperative complications between the two groups(P＞0.05).Patients in both groups were followed up for more than 12 months,and those in the Endo-TLIF group regained full weight-bearing activities significantly earlier than that in the MIS-TLIF group[(28.2±3.9)days vs(35.7±6.5)days,P＜0.001].The VASs both for lower back pain and leg pain,as well as ODI significantly decreased in both groups over time(P＜0.05).The Endo-TLIF was significantly better than the MIS-TLIF in terms low back pain VAS[(2.9±1.3)vs(4.1±1.7),P=0.006],leg pain VAS[(2.4±1.2)vs(3.2±1.3),P=0.026]and ODI scores[(10.7±3.1)vs(14.1±5.1),P=0.003]3 months postoperatively.As for imaging,the vertebral canal area and intervertebral space height were significantly increased in both groups after surgery compared with those preop-eratively(P＜0.05),whereas there were not statistically significant differences in the above imaging indexes and fusion grades between the two groups at corresponding time points(P＞0.05).[Conclusion]Endo-TLIF can achieve the same therapeutic effect as MIS-TLIF for sin-gle-level lumbar revision.By comparison,the Endo-TLIF has less trauma,fewer complications,faster postoperative recovery and higher safety over the MIS-TLIF.
关键词
腰椎翻修/内镜下手术/微创手术/经椎间孔椎体间融合术Key words
lumbar revision surgery/endoscopic surgery/minimally invasive surgery/transforaminal lumbar interbody fusion引用本文复制引用
出版年
2024
NETL
NSTL
万方数据