双操作通道全内镜下远外侧经椎间孔入路腰椎椎间融合术治疗腰椎滑脱症的临床疗效

Clinical efficacy of dual operation channels full-endoscopic far-lateral transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis

中文关键词:  腰椎滑脱症  双操作通道  全内镜  远外侧椎间孔入路  腰椎融合术

英文关键词:Lumbar spondylolisthesis  Dual-operation channels technique  Full-endoscopic  Far-lateral transforaminal approach  Lumbar interbody fusion

中文摘要:

  【摘要】 目的：分析双操作通道全内镜下远外侧经椎间孔入路腰椎椎间融合术治疗腰椎滑脱症的临床疗效。方法：回顾性分析2023年6月～2023年12月我科接受双操作通道全内镜下远外侧经椎间孔入路腰椎椎间融合术治疗的单节段腰椎滑脱症患者的临床资料共20例；其中退变性腰椎滑脱15例，峡部裂型腰椎滑脱5例；女7例，男13例；年龄49～72（59.95±7.16）岁；病程为2～120（35.15±42.10）个月。记录手术时间、术中出血量、住院时间及手术并发症，术前、术后1个月及末次随访时应用腰椎Oswestry功能障碍指数（Oswestry disability index，ODI）、腰痛及腿痛的视觉模拟评分（visual analog scale，VAS）评价疗效。对随访期间腰椎CT影像按照Bridwell标准判断椎间融合情况。结果：所有患者顺利完成镜下融合手术；手术时间为175～235min（201.75±24.40min）。所有病例随访时间为12～16（14.15±1.14）个月。术后1个月及末次随访时ODI、腰痛及腿痛VAS评分均较术前明显改善（P<0.05）。术中、术后及末次随访时均无严重并发症发生。随访期间20例复查腰椎CT，其中19例（95.0%）达到骨性融合。结论：双操作通道全内镜下远外侧经椎间孔入路腰椎椎间融合术早期随访临床疗效令人满意，是治疗腰椎滑脱症的一种微创、安全、有效的术式选择。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical efficacy of far-lateral transforaminal lumbar interbody fusion(TLIF) under a full-endoscope with dual-operation channels for the treatment of lumbar spondylolisthesis. Methods: A retrospective analysis was conducted on the clinical data of 20 patients with single-level lumbar spondylolisthesis who underwent dual-operation channels full-endoscopic far-lateral TLIF at the Department of Neck-shoulder and Lumbocrural Pain Division 1, Sichuan Orthopedic Hospital, from June 2023 to December 2023. Among the patients, there were 15 cases of degenerative spondylolisthesis and 5 cases of isthmic spondylolisthesis; 7 females and 13 males, aged 49 to 72 years(59.95±7.16 years). The duration of symptoms ranged from 2 to 120 months(35.15±42.10 months). The operative time, intraoperative blood loss, length of hospital stay, and surgical complications were recorded. Clinical outcomes were assessed using the Oswestry disability index(ODI) and visual analog scale(VAS) scores for back and leg pain, preoperatively, 1 month postoperatively, and at the final follow-up. Lumbar CT scans were used to evaluate interbody fusion according to the Bridwell criteria. Results: All the patients successfully underwent endoscopic fusion surgery. The operative time was 175min to 235min(201.75±24.40min). The follow-up period for all the cases was 12-16 months, with an average of 14.15±1.14 months. One month after surgery and final follow-up ODI, as well as VAS scores for both lower back pain and leg pain, showed significant improvement compared to preoperative levels(P<0.05). No serious complications occurred intraoperatively, postoperatively, or during the follow-up period. Of the 20 patients who underwent lumbar CT scans during the follow-up period, 19(95.0%) achieved solid bony fusion. Conclusions: The far-lateral TLIF under a dual-operation channels full-endoscope demonstrate satisfactory clinical outcomes in early follow-up, which offers a minimally invasive, safe, and effective option for the treatment of lumbar spondylolisthesis.