单侧双通道内镜辅助后路腰椎椎间融合术与微创经椎间孔腰椎椎间融合术治疗腰椎退变性疾病的临床疗效比较

Comparison of the clinical outcomes of unilateral biportal endoscopic assisted posterior lumbar interbody fusion with minimally invasive transforaminal lumbar interbody fusion in treating lumbar degenerative diseases

中文关键词:  单侧双通道内镜辅助后路腰椎椎间融合术  微创经椎间孔腰椎椎间融合术  腰椎退变性疾病  疗效比较

英文关键词:Unilateral biportal endoscopic assisted posterior lumbar interbody fusion  Minimally invasive transforaminal lumbar interbody fusion  Lumbar degenerative disease  Efficacy comparisons

中文摘要:

  【摘要】 目的：比较单侧双通道内镜辅助后路腰椎椎间融合术（unilateral biportal endoscopic assisted posterior lumbar interbody fusion，UBE-PLIF）与微创经椎间孔腰椎椎间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗腰椎退行性疾病的临床疗效。方法：回顾性分析2020年1月~2021年1月我院收治的60例腰椎退变性疾病患者临床资料，其中UBE-PLIF组27例，MIS-TLIF组33例。两组性别、年龄、病程、主要诊断、合并慢性疾病及手术节段等一般资料比较，差异均无统计学意义（P>0.05）。统计两组手术时间、术中失血量、术后引流量、住院天数，术前、术后3个月、术后6个月及末次随访的腰痛疼痛视觉模拟评分（visual analogue scale，VAS）、腿痛VAS评分、Oswestry功能障碍指数（ODI），术前和术后3d、3个月、6个月及末次随访的手术节段椎间隙高度（intervertebral disc height，IDH），术后6个月椎间融合情况、术后1年椎旁肌脂肪浸润分级及手术并发症。结果：两组患者均获随访，UBE-PLIF组随访12~15个月（13.3±1.0个月），MIS-TLIF组随访12~16个月（13.4±1.2个月），差异无统计学意义（P＞0.05）。UBE-PLIF组手术时间274.3±88.2min、术中出血量261.1±207.7ml、术后引流量95.7±79.7ml，MIS-TLIF组分别为181.8±58.7min、331.8±247.1ml、125.4±113.1ml，两组比较均有统计学差异（P＜0.05）；UBE-PLIF组住院天数7.4±2.3d，MIS-TLIF组7.5±1.0d，无统计学差异（P＞0.05）。两组患者腰痛、腿痛VAS评分及ODI在术后3个月、6个月及末次随访均较术前明显改善（P＜0.05）；两组患者术前、术后6个月及末次随访的腰痛及腿痛VAS评分差异均无统计学意义（P＞0.05），术后3个月腰痛及腿痛VAS评分UBE-PLIF组优于MIS-TLIF组（P＜0.05）；术前、术后3个月、术后6个月及末次随访ODI两组患者间差异无统计学意义（P＞0.05）。两组患者术后3d、3个月、6个月及末次随访IDH均较术前有所改善，差异有统计学意义（P＜0.05）；术前和术后3d、3个月、6个月及末次随访IDH两组间比较均无统计学差异（P＞0.05）。术后6个月植骨融合评估，UBE-PLIF组I级融合23例、Ⅱ级4例，MIS-TLIF组I级28例、Ⅱ级5例，两组比较无统计学差异（P＞0.05）。术后1年椎旁肌脂肪浸润分级，UBE-PLIF组1级2例、2级18例、3级7例，MIS-TLIF组1级0例、2级15例、3级18例，两组间比较有统计学差异（P＜0.05）。两组患者均未发生手术相关并发症。结论：UBE-PLIF治疗腰椎退变性疾病的临床疗效与MIS-TLIF相近，术后3个月UBE-PLIF组腰腿痛症状较MIS-TLIF组明显改善，并且UBE-PLIF具有创伤小、术中出血少、术后引流少等优点。

英文摘要:

  【Abstract】 Objectives: To compare the clinical outcomes of unilateral biportal endoscopic assisted posterior lumbar interbody fusion(UBE-PLIF) with minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative diseases. Methods: A retrospective case-control study was performed to analyze the clinical data of 60 patients with lumbar degenerative diseases who were admitted and treated in our hospital between January 2020 and January 2021, including 27 patients in UBE-PLIF group and 33 patients in MIS-TLIF group. There were no statistical differences(P>0.05) in the general data such as gender, age, surgical segment, disease duration, main diagnosis, and comorbid chronic diseases between the two groups. The operative time, intraoperative blood loss, postoperative drainage volume, and hospital stays were compared between the two groups. The visual analogue scale(VAS) scores for low back pain and leg pain, and Oswestry disability index(ODI) were collected preoperatively, at postoperative 3 months, 6 months, and final follow-up. The intervertebral disc height(IDH) of the operated segments was calculated before operation, at postoperative 3 days, 3 months, 6 months, and final follow-up. And the status of interbody fusion at 6 months after operation, fat infiltration grade of paraspinal muscles at 1 year after surgery, and complications were counted. Results: Patients in UBE-PLIF group were followed up for 12-15 months(13.3±1.0 months), and patients in MIS-TLIF group were followed up for 12-16 months(13.4±1.2 months) , and the differences were not statistically significant(P>0.05). The operative time, intraoperative blood loss, and postoperative drainage volume in UBE-PLIF group and MIS-TLIF group were respectively 274.3±88.2min and 181.8±58.7min, 261.1±207.7ml and 331.8±247.1ml, and 95.7±79.7 and 125.4±113.1ml, and the differences between groups were with statistical significance(P<0.05); Hospitalization days were 7.4±2.3 days in the UBE-PLIF group and 7.5±1.0 days in the MIS-TLIF group, and there was no statistical difference(P>0.05). The low back pain VAS score, leg pain VAS score, and ODI of patients in both groups at postoperative 3 months, 6 months, and final follow-up all improved significantly(P<0.05) from their preoperative values; the VAS scores of low back pain and leg pain at preoperation, postopertive 6 months, and final follow-up were with no statistical differences between groups(P>0.05), while those at 3 months of follow-up in UBE-PLIF group were superior than in MIS-TLIF group(P<0.05); There was no significant difference in ODI between the two groups at preoperation, 3 months, 6 months, and final follow-up(P>0.05). IDH of all groups of patients at 3 days, 3 and 6 months after surgery, and final follow-up was improved compared with the preoperative values, with significant differences(P<0.05), while there was no statistical difference between the two groups at such time points(P>0.05). For the bone graft fusion conditions at 6 months after surgery, 23 patients were of grade Ⅰ and 4 of grade Ⅱ in the UBE-PLIF group, and 28 patients were of grade Ⅰ and 5 of grade Ⅱ in the MIS-TLIF group, respectively(P＞0.05). As for the grades of paraspinal muscle fatty infiltration at 1 year after surgery, there were 2 patients of grade 1, 18 patients of grade 2, and 7 patients of grade 3 in the UBE-PLIF group and 0 patients of grade 1, 15 patients of grade 2, and 18 patients of grade 3 in the MIS-TLIF group, respectively, and the differences were with statistical significance(P<0.05). No patient in both groups developed operation related complications. Conclusions: Comparing with MIS-TLIF, UBE-PLIF has similar clinical efficacy in treating lumbar degenerative diseases, and the symptoms of low back and leg pain at 3 months after surgery are significantly improved, which also has the advantages such as less trauma, less intraoperative bleeding and less postoperative drainage.