单侧双通道内镜下腰椎间融合术与微型开放经椎间孔腰椎间融合术治疗单节段腰椎退行性疾病的临床疗效比较

Comparison of clinical efficacies between unilateral biportal endoscopic lumbar interbody fusion and mini-open transforaminal lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease

中文关键词:  腰椎退行性疾病  单侧双通道内镜下腰椎间融合术  微型开放经椎间孔腰椎间融合术  临床疗效

英文关键词:Lumbar degenerative disease  Unilateral double-channel endoscopic lumbar interbody fusion  Mini-open transforaminal lumbar interbody fusion  Clinical efficacy

中文摘要:

  【摘要】 目的：比较单侧双通道脊柱内镜下腰椎间融合术（unilateral biportal endoscopic lumbar interbody fusion，UBE-LIF）与微型开放经椎间孔腰椎间融合术（mini-open transforaminal lumbar interbody fusion，m-TLIF）治疗单节段腰椎退行性疾病（lumbar degenerative disease，LDD）的早期临床疗效。方法：回顾性分析2019年10月~2023年10月在我院骨科治疗的60例单节段LDD患者，其中男33例，女27例；年龄55~71岁（65.0±4.5岁）。根据手术方式，分为UBE-LIF组（n=30，手术节段L3/4 2例，L4/5 22例，L5/S1 6例）和m-TLIF组（n=30，手术节段L3/4 4例，L4/5 16例，L5/S1 10例）。两组在性别、年龄、术前诊断及手术节段方面均无显著性差异（P>0.05）。统计并比较两组手术时间、术中出血量、切口总长度、术后2d引流量、术后下地时间、术后住院时间；比较术前、术后3个月、6个月及末次随访时的腰椎前凸角（lumbar lordosis angle，LLA）、椎间盘高度（intervertebral disc height，IDH）及术后6个月和末次随访时的融合率；比较术前、术后1d、3个月、6个月及末次随访时的腰腿痛视觉模拟量表（visual analogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）。统计术中及随访时并发症发生情况，术后3个月、6个月及末次随访时依据改良MacNab标准评估优良率。结果：所有患者手术均顺利完成，随访时间12~14个月（12.5±0.7个月）。UBE-LIF组手术时间长于m-TLIF组（190.9±69.0min vs 151.4±32.1min，P<0.05），但术中出血量（87.9±43.2mL vs 126.5±74.1mL）、切口总长度（6.1±0.2cm vs 8.5±1.3cm）、术后2d引流量（20.8±8.4mL vs 74.7±48.7mL）、术后下地时间（2.1±1.2d vs 2.8±1.3d）、术后住院时间（5.4±0.9d vs 7.4±1.1d）均明显少于m-TLIF组（P<0.05）。术后3个月、6个月及末次随访时两组的LLA和IDH均优于术前，差异有统计学意义（P<0.05），但各时间点两组间比较无统计学差异（P>0.05）。末次随访时两组患者均达骨性融合，融合率为100%。两组术后3个月、6个月、末次随访时腰腿痛VAS评分和ODI均低于术前，并且在术后早期（1d、3个月）腰腿痛VAS评分UBE-LIF组优于m-TLIF组（P<0.05），其余随访各时间点两组间比较差异无统计学意义（P>0.05）。末次随访时UBE-LIF组改良MacNab标准优良率为90.00%（27/30），m-TLIF组为86.67%（26/30），两组间无统计学差异（P>0.05）。m-TLIF组术中发生1例硬膜撕裂，术中予以硬膜修补后随访良好，两组均未发生硬膜外血肿、切口感染、内固定物松动或断裂等并发症，术中及术后随访并发症发生率两组差异均无统计学意义（P>0.05）。结论：UBE-LIF和m-TLIF治疗单节段LDD均可获得满意疗效，相较于m-TLIF，UBE-LIF具有创伤小、术后早期腰腿痛缓解明显、功能恢复快等优点。

英文摘要:

  【Abstract】 Objectives: To compare the early clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF) with mini-open transforaminal lumbar interbody fusion(m-TLIF) in the treatment of single-level lumbar degenerative disease(LDD). Methods: A retrospective analysis was performed on 60 patients with single-level LDD treated in the Department of Orthopedics at our hospital between October 2019 and October 2023. There were 33 males and 27 females, aged 55-71 years(65.0±4.5 years). The patients were divided into the UBE-LIF group(n=30, operative segment: L3/4 2 cases, L4/5 22 cases, L5/S1 6 cases) and m-TLIF group(n=30, operative segment: L3/4 4 cases, L4/5 16 cases, L5/S1 10 cases) according to the surgical approach. There were no significant differences between the two groups in terms of gender, age, preoperative diagnosis, or operative segment(P>0.05). The two groups were statistically compared in terms of operative time, intraoperative blood loss, total incision length, drainage volume on the second postoperative day, postoperative ambulation time, and hospital stay. Lumbar lordosis angle(LLA), intervertebral disc heigh(IDH) were compared before operation, at 3 months, 6 months after operation, and final follow-up, and fusion rate was also compared at 6 months after operation and final follow-up. Visual analogue scale(VAS) score for low back and leg pain and Oswestry disability index(ODI) were compared before operation, at 1d, 3 months and 6 months after operation, and final follow-up. Intraoperative and follow-up complications were also compared, and at postoperative 3 months and 6 months, and final follow-up excellent and good rates were evaluated according to the modified MacNab criteria. Results: All the patients underwent successful surgery, with a follow-up period of 12 to 14 months(12.5±0.7 months). UBE-LIF group was longer in operative time than the m-TLIF group(190.9±69.0min vs 151.4±32.1min, P<0.05), but the intraoperative blood loss(87.9±43.2mL vs 126.5±74.1mL), total incision length(6.1±0.2cm vs 8.5±1.3cm), drainage volume on the second postoperative day(20.8±8.4mL vs 74.7±48.7mL), postoperative ambulation time(2.1±1.2d vs 2.8±1.3d), and hospital stay(5.4±0.9d vs 7.4±1.1d) were significantly less than those in the m-TLIF group(P<0.05). Postoperative LLA and IDH outcomes were significantly better in both groups at 3 months, 6 months, and final follow-up compared with preoperative conditions(P<0.05), but no significant differences were observed between the two groups(P>0.05). At final follow-up, the two groups of patients achieved bony fusion, with a fusion rate of 100%. VAS scores for low back and leg pain and ODI were lower in both groups at 3 months, 6 months, and final follow-up compared with preoperative values. In the early postoperative period (1d and 3 months), the VAS scores of low back and leg pain in the UBE-LIF group were lower than those in the m-TLIF group(P<0.05). There were no significant differences between the two groups at other follow-up time points(P>0.05). At final follow-up, the modified MacNab criteria-based excellent and good rates were 90.00%(27/30) in the UBE-LIF group and 86.67%(26/30) in the m-TLIF group, with no statistically significant difference between the two groups(P>0.05). One dural tear occurred intraoperatively in the m-TLIF group, and the patient underwent dural repair and had good follow-up. No complications, including epidural hematoma, wound infection, or hardware loosening or breakage, occurred in either group. There was no statistically significant difference in the incidence of complications between the two groups during either intraoperative or postoperative follow-up(P>0.05). Conclusions: Both UBE-LIF and m-TLIF achieved satisfactory results in the treatment of single-segment LDD. Compared with m-TLIF, UBE-LIF offers advantages such as small trauma, significant early relief of low back and leg pain, and rapid functional recovery.