后外侧入路经皮内窥镜下腰椎椎间融合术治疗腰椎滑脱症的临床疗效分析

Preliminary clinical efficacy of posterolateral endoscopic lumbar interbody fusion for lumbar spondylolisthesis

中文关键词:  脊柱内窥镜  腰椎融合术  微创  腰椎滑脱症

英文关键词:Spinal endoscope  Lumbar interbody fusion  Minimally invasive  Lumbar spondylolisthesis

中文摘要:

  【摘要】 目的：分析后外侧入路经皮内窥镜下腰椎椎间融合术（posterolateral endoscopic lumbar interbody fusion，PELIF）治疗腰椎滑脱症的安全性和早期疗效。方法：回顾性分析2018年3月~2019年9月我科行PELIF治疗的22例轻度腰椎滑脱症患者。其中男性9例，女性13例；年龄为36~77岁，平均55.1±11.3岁。单节段滑脱21例，双节段滑脱1例。Ⅰ度滑脱19个节段，Ⅱ度滑脱4个节段。手术时间170.7±23.4min，术后随访12~29个月，平均20.3±3.0个月。手术前、术后2周、术后6个月和末次随访时采用视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评价临床疗效。术前、术后2周和末次随访时拍摄腰椎X线片并测量手术节段椎间隙高度、腰椎前凸角、手术节段前凸角、腰椎滑脱率，术后12个月通过CT评估融合率。同时记录随访期间手术并发症。结果：术前患者腰痛VAS为7.14±0.83分，术后2周为3.23±0.69分，术后6个月为2.91±0.53分，末次随访为2.32±0.57分；术前腿痛VAS为6.82±0.80分，术后2周为2.91±0.61分，术后6个月为2.60±0.50分，末次随访为2.28±0.63分；术前ODI为（65.60±10.28）%，术后2周为（19.59±6.54）%，术后6个月为（15.95±5.27）%，末次随访为（13.45±3.63）%；术后2周、6个月和末次随访时腰痛、腿痛VAS评分及 ODI 均较术前明显降低（P＜0.05）。术前手术节段椎间隙高度为9.23±2.11mm，术后2周为11.77±2.07mm，末次随访为11.04±1.67mm，差异有统计学意义（P＜0.05）；腰椎前凸角术前、术后2周、末次随访差异无统计学意义（P＞0.05）。手术节段前凸角术前为12.39°±8.42°，术后2周为15.17°±8.90°，末次随访为15.09°±6.44°，差异有统计学意义（P＜0.05）；腰椎滑脱率术前为（39.70±6.01）%，末次访为（14.50±2.88）%，差异有统计学意义（P＜0.05）；本组病例滑脱复位率为59.9%。术后12个月时，所有病例均获得骨性融合。1例神经根袖损伤，另有一过性腰大肌无力1例，经保守治疗均获得痊愈；无感染、血肿、内固定失败等其他并发症。结论：PELIF治疗腰椎滑脱症安全可靠，短期临床疗效满意，但其远期疗效仍需进一步随访观察。

英文摘要:

  【Abstract】 Objective: To analyze the safety and early efficacy of posterolateral endoscopic lumbar interbody fusion(PELIF) in the treatment of lumbar spondylolisthesis. Methods: Data of 22 patients with lumbar spondylolisthesis underwent PELIF admitted to our department from March 2018 to September 2019 were retrospective reviewed. There were 9 males and 13 females, averaged 55.1±11.3 years old (36 to 77). Among them, there were 21 cases of single-level spondylolisthesis and 1 case of double-level spondylolisthesis. The operation time was 170.7±23.4min, and the postoperative follow-up period was 20.3±3.0 months(12-29 months). The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) before surgery, 2 weeks after surgery, 6 months after surgery, and at final follow-up. X-rays were taken preoperatively, 2 weeks postoperatively, and at final follow-up to measure the height of intervertebral space, physiological angle, and the rate of lumbar spondylolisthesis at surgical segments. The fusion rate was evaluated by CT one year postoperatively. Perioperative complications were also recorded. Results: The VAS of back pain was 7.14±0.83 points before operation, 3.23±0.69 points at 2 weeks postoperatively, 2.91±0.53 points at 6 months after operation, and 2.32±0.57 points at final follow-up. The leg VAS was 6.82±0.80 before operation, 2.91±0.61 at 2 weeks postoperatively, 2.60±0.50 at 6 months postoperatively, and 2.28±0.63 at final follow-up. The ODI was (65.60±10.28)% preoperatively, (19.59±6.54)% at 2 weeks postoperatively, (15.95±5.27)% at 6 months postoperatively, and (13.45±3.63)% at final follow-up. The back pain and leg pain VAS scores, and ODI at 2-week, 6-month, and final follow-up were significantly lower than those before surgery, and the differences were statistically significant(P<0.05). The height of the intervertebral space was 9.23±2.11mm at pre-op, 11.77±2.07mm at 2 weeks postoperatively, and 11.04±1.67mmat final follow-up(P<0.05). The lordotic angle was 12.39°±8.42° before operation, 15.17°±8.90° at 2 weeks postoperatively, and 15.09°±6.44° at final follow-up(P<0.05). The lumbar spondylolisthesis rate was improved from (39.70±6.01)% preoperatively to(14.50±2.88)% at final follow-up(P<0.05). The reduction rate of spondylolisthesis at final follow-up was 59.9%. At 12-month postoperatively, all cases achieved bony fusion. In this group of cases, there was one case of nerve root sleeve injury and one case of transient psoas major muscle weakness cured after conservative treatment. No infection, hematoma, internal fixation failure and other complications occurred. Conclusions: PELIF is highly safety in the treatment of lumbar spondylolisthesis, and the short-term clinical effect is satisfactory. Yet, its long-term effect still needs further follow-up observation.