单侧双通道内镜下经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的早期疗效分析

The early clinical efficacy analysis of unilateral biportal endoscopic transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  腰椎椎间融合术  内镜手术  单侧双通道

英文关键词:Lumbar degenerative diseases  Lumbar interbody fusion  Endoscopic surgery  Unilateral biportal

中文摘要:

  【摘要】 目的：评估单侧双通道内镜下经椎间孔腰椎椎间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF/BETLIF）治疗腰椎退行性疾病的早期临床疗效。方法：选取2019年3月~2021年5月行BETLIF治疗的腰椎退行性疾病患者共60例，其中Ⅰ度退行性腰椎滑脱33例（L3/4 1例，L4/5 27例，L5/S1 5例），Ⅰ度退行性腰椎滑脱伴峡部裂6例（L3/4 1例，L4/5 3例，L5/S1 2例），腰椎间盘突出症伴节段不稳15例（L4/5 14例，L5/S1 1例），腰椎椎管狭窄症伴腰椎不稳5例（L3/4 1例，L4/5 4例），单纯腰椎不稳1例（L4/5 1例）；男14例，女46例，年龄38~70岁（56±8岁），体质指数（body mass index，BMI）25.2±3.0kg/m2。统计手术时间、术后引流量、下地时间、术后住院时间及并发症；统计患者术前和术后1周、1个月、3个月及6个月的腿痛和腰背痛视觉模拟评分（visual analogue scale，VAS）、术前及术后1、3、6个月Oswestry功能障碍指数（Oswestry disability index，ODI）和术后6个月改良Macnab标准。计算术后6个月腿痛VAS、腰背痛VAS、ODI改善率；采用单因素重复测量方差分析比较腿痛/腰背痛VAS评分和ODI在术前及术后各时间点是否有统计学差异，采用配对样本t检验比较术后6个月腿痛VAS与腰背痛VAS改善率差异；两名脊柱外科医生根据Bridwell椎间融合分级标准在X线/CT上统计术后6个月手术节段融合情况。结果：60例患者平均手术时间为145.9±12.6min；术后留置引流管35例（58.3%），平均引流量为56.40ml；术后下地时间为2.9±1.0d；术后住院时间为7.8±2.7d。术中硬脊膜撕裂2例，术后切口皮下水肿3例。患者术后1周及1、3、6个月的腿痛、腰背痛VAS评分均明显小于术前（P＜0.05）；术后6个月腿痛VAS改善率为（65.6±7.1）%，腰背痛VAS改善率为（62.3±7.2）%，腿痛比腰背痛改善更佳（P＜0.05）。术后1、3、6个月的ODI均明显小于术前（P＜0.05），术后6个月ODI改善率为（60.9±4.7）%。术后6个月复查X线/CT结果显示节段发生融合26例（43.4%），有融合趋势但尚未完全融合29例（48.3%），未发生融合5例（8.3%）。术后6个月改良Macnab标准评估为优55例（91.7%），良5例（8.3%）。结论：BETLIF是一种安全、有效的腰椎椎间融合术，治疗腰椎退行性疾病能够获得良好的早期临床疗效。

英文摘要:

  【Abstract】 Objectives: To evaluate the early clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF/BETLIF) in the treatment of lumbar degenerative diseases. Methods: 60 patients with lumbar degenerative diseases who underwent BETLIF surgery from March 2019 to May 2021 were selected, including 33 cases of grade Ⅰ degenerative lumbar spondylolisthesis (L3/4 1 case, L4/5 27 cases, L5/S1 5 cases), 6 cases of grade Ⅰ degenerative lumbar spondylolisthesis with isthmus fissure(L3/4 1 case, L4/5 3 cases, L5/S1 2 cases), 15 cases of disc herniation with segmental instability(L4/5 14 cases， L5/S1 1 case), 5 cases of lumbar spinal stenosis with segmental instability(L3/4 1 case, L4/5 4 cases), and 1 case of simple lumbar instability(L4/5 1 case). There were 14 males and 46 females, aged from 38 to 70 years old, averaged 56±8 years; with a mean body mass index(BMI) of 25.2±3.0kg/m2. The operative time, postoperative drainage, ambulation time, postoperative length of hospital stay and complications were recorded. The visual analogue scale(VAS) of leg and low back pain was collected before operation, at postoperative 1 week, and 1, 3, and 6 months; Oswestry disability index(ODI) was collected before operation, at postoperative 1, 3, and 6 months; the modified Macnab criteria grade was recorded at the 6th month after operation. The improvement rate of VAS scores of leg pain and low back pain and ODI 6-month postoperatively were calculated. The VAS score of leg pain/low back pain and ODI before and after operation were analysed according to the one-way repeated measures ANOVA for statistical difference, the differences of improvements between postoperative 6-month VAS score of leg pain and low back pain 6-month postoperatively were compared by paired sample t-test. According to Bridwell interbody fusion grading system, the surgical segmental fusion was evaluated on X-ray/CT images at 6-month after operation by two spinal surgeons. Results: The average operative time was 145.9±12.6min. 35 cases out of 60(58.3%) had indwelling drainage tubes after operation, with an average drainage volume of 56.40ml. The average ambulation time was 2.9±1.0d, and the average postoperative hospital stay was 7.8±2.7d. The surgical complications included intraoperative dural tear in 2 cases and postoperative subcutaneous edema in 3 cases. The VAS scores of leg and low back pain at 1 week and 1, 3 and 6 months after operation were significantly lower than those before operation(P＜0.05). The improvement rate of the VAS scores of leg pain and low back pain 6-month postoperatively were (65.6±7.1)% and (62.3±7.2)% respectively, with leg pain VAS better improved than low back pain VAS(P<0.05). The ODI at 1, 3 and 6 months after operation were significantly lower than those before operation(P<0.05), and the improvement rate of the ODI 6-month postoperatively were (60.9±4.7)%. The X-ray/CT at 6 months after operation revealed that 26 cases(43.4%) had segmental fusion, 29 cases(48.3%) had fusion trends but not fused, and 5 cases(8.3%) showed no segmental fusion at all. According to modified Macnab criteria, 55 patients were excellent(91.7%) and 5 patients were good(8.3%) at 6-month after operation. Conclusions: As a safe and effective lumbar interbody fusion technique, BETLIF has great early clinical efficacy for the treatment of lumbar degenerative diseases.