环锯一次成形技术在单通道内镜下经关节突入路腰椎间融合术中的应用效果

Application of trephonic one-off plasty technique in uniportal percutaneous endoscopic lumbar interbody fusion via transarticular approach

中文关键词:  环锯一次成形技术  经皮内镜下腰椎间融合术  经关节突入路  腰椎退行性疾病  手术效率

英文关键词:Trephonic one-off plasty  Percutaneous endoscopic lumbar interbody fusion  Transarticular approach  Lumbar degenerative disease  Surgical efficiency

中文摘要:

  【摘要】 目的：探讨环锯一次成形（trephonic one-off plasty，TOP）技术在单通道关节突入路经皮内镜下腰椎间融合术（percutaneous endoscopic lumbar interbody fusion，PE-LIF）应用中的安全性和有效性。方法：本研究为前瞻性随机对照研究，将2022年1月～2023年12月期间在我院接受PE-LIF治疗的单节段腰椎退行性疾病患者随机分为对照组和观察组。对照组，男性17例，女性23例，年龄57.3±12.9岁，采用传统经关节突入路手术方式；观察组，男性12例，女性27例，年龄60.7±9.0岁，采用TOP技术。记录患者一般资料、显露Kambin三角的手术时间和透视次数、总手术时间、早期并发症；记录术前、术后3d、术后3个月和术后1年时Oswestry功能障碍指数（Oswestry disability index，ODI）；用改良Macnab疗效评定标准评估患者术后疗效、Sanghvi腰椎融合评估方法进行融合率的评定，并对两组间数据进行统计分析。结果：两组间术前一般资料无统计学差异（P＞0.05），观察组总手术时间和显露Kambin三角用时均显著少于对照组（135.7±16.3min vs 163.1±23.3min，P＜0.001；11.4±5.1min vs 31.5±9.4min，P＜0.001），但在显露Kambin三角透视次数上显著多于对照组（10.5±4.4次 vs 1.3±1.5次，P＜0.001）。两组间早期并发症发生率无统计学差异（P＞0.05）。术前、术后3d、术后3个月及术后1年时两组间ODI均无统计学差异（P＞0.05）。两组间术后优良率（对照组82.5% vs 观察组89.7%，P＞0.05）、术后1年融合率（对照组90.0% vs 观察组94.9%，P＞0.05）无统计学差异。结论：TOP技术能够安全、有效地提高经关节突入路PE-LIF手术效率，有助于椎管减压，能够达到与传统手术相当的治疗效果。

英文摘要:

  【Abstract】 Objectives: To investigate the safety and efficacy of trephonic one-off plasty(TOP) in percutaneous endoscopic lumbar interbody fusion(PE-LIF) via a transarticular approach. Methods: This prospective randomized controlled trial enrolled patients with single-level lumbar degenerative disease who underwent PE-LIF at our hospital between January 2022 and December 2023. Participants were randomly assigned to either the control group(n=40, 17 males and 23 females, mean age 57.3±12.9 years) received conventional transarticular approach surgery or the observation group(n=39, 12 males and 27 females, mean age 60.7±9.0 years) treated with the TOP technique. Parameters including baseline characteristics, time required to expose Kambin′s triangle, intraoperative fluoroscopy frequency, total operative time, early complications were recorded; Oswestry disability index(ODI) was recorded preoperatively, 3d, 3 months, and 1 year postoperatively. Postoperative outcomes were assessed using the modified Macnab criteria, and fusion rate was assessed with the Sanghvi lumbar fusion evaluation method. Statistical analyses were performed to compare intergroup differences. Results: No significant baseline differences existed between groups(P>0.05). The observation group demonstrated significantly shorter total operative time(135.7±16.3min vs 163.1±23.3min, P<0.001) and Kambin′s triangle exposure time(11.4±5.1min vs 31.5±9.4min, P<0.001) but required more fluoroscopic exposures(10.5±4.4 vs 1.3±1.5, P<0.001). Early complication rates showed no statistical difference(P>0.05). There was no statistical differences between the two groups in ODI at any time point(preoperatively, and 3d, 3 months, and 1 year postoperatively)(P>0.05). No significant differences were observed in excellent and good rates(82.5% vs 89.7%, P>0.05) or fusion rate one year after operation(90.0% vs 94.9%, P＞0.05). Conclusions: The TOP technique safely and effectively enhances the efficiency of transarticular PE-LIF, facilitates spinal decompression, and achieves therapeutic outcomes comparable to conventional methods.