经皮内镜下经椎板间入路与微创经椎间孔入路椎间融合术治疗Ⅰ、Ⅱ度腰椎滑脱症的临床疗效对比

A comparison of the clinical efficacies of lumbar interbody fusion via percutaneous endoscopic interlaminar approach and minimally invasive transforaminal approach in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis

中文关键词:  腰椎滑脱症  经皮内镜经椎板间腰椎椎体间融合术  微创经椎间孔腰椎体间融合术  疗效

英文关键词:Lumbar spondylolisthesis  Percutaneous endoscopic posterior lumbar interbody fusion  Minimally invasive transforaminal lumbar interbody fusion  Efficacy

中文摘要:

  【摘要】 目的：比较经皮脊柱内镜下经椎板间腰椎椎体间融合术（percutaneous endoscopic posterior lumbar interbody fusion，PE-PLIF）与微创经椎间孔腰椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗Ⅰ、Ⅱ度腰椎滑脱症的临床疗效。方法：回顾性分析新疆医科大学第六附属医院微创脊柱外科2020年1月~2022年1月因单节段腰椎滑脱症患者采用PE-PLIF与MIS-TLIF治疗的70例患者临床资料，男33例、女37例；年龄59.6±11.0岁；根据不同手术方式分为PE-PLIF组36例，MIS-TLIF组34例。收集并比较两组手术时间、术中出血量，术后3d的肌酸激酶（creatine kinase，CK）、C反应蛋白（C-reactive protein，CRP）及白细胞介素-6（interleukin6，IL-6）等血清学指标，术前和术后1周、3个月、6个月及1年时的腰腿痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI），依据Bridwell融合标准，术后2年采用三维重建CT评估椎间融合情况，记录术后并发症。结果：所有患者手术顺利，PE-PLIF组术中出血量较MIS-TLIF组明显减少（91.6±45.8mL vs 195.5±126.3mL，P=0.000）；但手术时间较MIS-TLIF组长（227.5±58.0min vs 194.1±55.2min，P=0.016）；术后3d PE-TLIF组CK、CRP、IL-6明显低于MIS-TLIF组（P＜0.05）。两组术后腰腿痛VAS评分、ODI均较术前明显改善，术后1周PE-PLIF组腰痛VAS评分较MIS-TLIF组改善更加明显（P=0.02），余时间点腰痛VAS评分无统计学差异（P＞0.05），两组各时间点腿痛VAS评分、ODI无统计学差异（P＞0.05）。两组术后2年融合率无统计学差异（PE-PLIF组86%，MIS-TLIF组94%，P=0.430）；两组术后均未出现严重并发症需翻修手术情况。结论：PE-PLIF治疗Ⅰ、Ⅱ度腰椎滑脱症手术创伤较小，术后早期腰痛缓解情况优于MIS-TLIF；在中长期两种手术技术临床效果无明显差异。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of percutaneous endoscopic posterior lumbar interbody fusion(PE-PLIF) and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis. Methods: The clinical data of 70 patients with single level lumbar spondylolisthesis treated with PE-PLIF or MIS-TLIF in the Department of Minimally Invasive Spinal Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2020 and January 2022 were analyzed retrospectively, including 33 males and 37 females, aged 59.6±11.0 years old. According to different surgical methods, the patients were divided into PE-PLIF group of 36 cases and MIS-TLIF group of 34 cases. The operative time, intraoperative blood loss, postoperative 3d serum indexes such as creatine kinase(CK), C-reactive protein(CRP) and interleukin-6(IL-6) were collected and compared between groups, as well as low back and leg pain visual analogue scale(VAS) and Oswestry disability index(ODI) before operation, at 1 week, and 3 and 6 months, and 1 year after operation. 3D reconstruction CT was used to evaluate interbody fusion according to the Bridwell′s fusion grading system at 2 years after operation, and postoperative complications were also documented. Results: PE-PLIF group was significantly less than MIS-TLIF group in intraoperative blood loss(91.6±45.8mL vs 195.5±126.3mL, P=0.000), longer in operative time(227.5±58.0min vs 194.1±55.2min, P=0.016), and lower postoperative 3d CK, CRP, IL-6(P<0.05). The VAS score and ODI in both groups were significantly improved compared with those before operation, while the VAS score in PE-PLIF group improved more obvious than that in MIS-TLIF group at one week after operation(P=0.02), and no statistically significant difference was there in the VAS scores between groups at other time points(P>0.05). PE-PLIF group wasn′t significantly different from MIS-TLIF group in the fusion conditions at 2 years after operation(86% vs 94%, P=0.430); There were no serious complications requiring revision surgery in both groups. Conclusions: PE-PLIF is less traumatic and relieves low back pain better at early postoperation than MIS-TLIF in the treatment of grade Ⅰ and grade Ⅱ lumbar spondylolisthesis, while PE-PLIF isn′t significantly differ from MIS-TLIF in mid-to-long term clinical efficacy.