两种经椎间孔减压椎间融合术治疗腰椎退行性疾病的疗效及多裂肌损伤对比

Comparison of clinical outcomes and postoperative multifidus injury between two kinds of transforaminal lumbar interbody fusion in the treatment of lumbar degenerative disease

中文关键词:  经椎间孔腰椎椎间融合术  双通道内镜  Wiltse入路  多裂肌萎缩率

英文关键词:Transforaminal lumbar interbody fusion  Biportal endoscopy  Wiltse approach  Multifidus atrophy rate

中文摘要:

  【摘要】 目的：对比分析单侧双通道内镜下经椎间孔减压椎间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）与椎旁肌间隙（Wiltse）入路经椎间孔减压椎间融合术（transforaminal lumbar interbody fusion via Wiltse approach，W-TLIF）治疗腰椎退行性疾病的疗效及多裂肌损伤情况。方法：回顾性分析2020年1月～2021年2月于我院接受经椎间孔减压融合手术的48例腰椎退行性疾病患者的临床资料。根据手术方式将患者分为UBE-TLIF组（n=25）和W-TLIF组（n=23）。UBE-TLIF组男性9例，女性16例，年龄62.1±12.7岁；W-TLIF组男性11例，女性12例，年龄58.7±14.3岁。比较两组手术时间、术中出血量、术后引流量及术后住院天数，术前和术后1天、3个月、6个月、1年时的腰腿痛视觉模拟评分（visual analogue scales，VAS）及术前和术后3个月、6个月、1年时的Oswestry功能障碍指数（Oswestry disability index，ODI）。术后1年采用改良Macnab标准评估临床疗效，采用Bridwell标准评估植骨融合情况。比较术前、术后1天的血清肌酸激酶（creatine kinase，CK）水平，测量并计算术后3个月、6个月、1年时多裂肌的萎缩率和脂肪浸润率，评估多裂肌损伤情况。统计并分析两组手术并发症及翻修情况。结果：所有患者顺利完成手术。与W-TLIF组比较，UBE-TLIF组手术时间更短（159.9±27.5min vs 183.8±27.8min，P＜0.05），术中出血量更少（69.6±44.7ml vs 144.8±77.7ml，P＜0.05），术后引流量更少（91.4±73.6ml vs 168.9±126.2ml，P＜0.05）。两组患者术后各时间点的腰腿痛VAS评分及ODI与术前比较均有显著性改善（P＜0.05），两组同时间点比较均无显著性差异（P＞0.05）。术后1年UBE-TLIF组改良Macnab标准优良率为88%，W-TLIF组为87%，两组无统计学差异（P＞0.05）。术后1年UBE-TLIF组融合率为96%，W-TLIF组为91.3%，两组无统计学差异（P＞0.05）。术后1天两组患者血清CK水平较术前显著性升高（P＜0.05），两组同时间点比较无统计学差异（P＞0.05）；两组患者术后相同随访时间点多裂肌萎缩率及脂肪浸润率均无显著性差异（P＞0.05）。UBE-TLIF组手术并发症发生率为8%（2/25），W-TLIF组为13%（3/23），两组差异无统计学意义（P＞0.05）。两组均无翻修病例。结论：UBE-TLIF与W-TLIF治疗腰椎退行性疾病均能取得满意且相似的临床疗效，两组椎间融合率及多裂肌萎缩率相近，但UBE-TLIF治疗腰椎退行性疾病手术时间短，术中出血量少，术后引流量少。

英文摘要:

  【Abstract】 Objectives: To compare and analyze the clinical outcomes and postoperative multifidus injury conditions between unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) and transforaminal lumbar interbody fusion via the Wiltse approach(W-TLIF) in the treatment of lumbar degenerative disease(LDD). Methods: A retrospective analysis was performed on 48 patients with LDD treated with transforaminal lumbar interbody fusion between January 2020 and February 2021 in our hospital. The patients were divided into the UBE-TLIF group(n=25) and the W-TLIF group(n=23) according to different surgical methods. The UBE-TLIF group consisted of 9 males and 16 females, with an average age of 62.1±12.7 years, while the W-TLIF group consisted of 11 males and 12 females, with an average age of 58.7±14.3 years. The operative time, intraoperative bleeding, postoperative drainage volume, and postoperative hospital stay were compared between the two groups, as well as the visual analogue scale(VAS) for low back and leg pain before surgery, at 1 day, 3 and 6 months, and 1 year after surgery, and Oswestry disability index(ODI) before surgery, at 3 and 6 months, and 1 year after surgery. Modified Macnab criteria were employed to evaluate the clinical efficacy and the Bridwell criteria were used to evaluate the bone graft fusion at one year after surgery. Serum creatine kinase(CK) levels were compared between pre-operation and 1 day after operation, and the atrophy rate and fat infiltration of multifidus muscle were measured and calculated at 3 months, 6 months, and 1 year after operation to evaluate the injury of multifidus muscle. Surgical complications and revision rates were counted and anlyzed between the two groups. Results: The surgery went uneventfully in all the patients. Comparing with the W-TLIF group, the UBE-TLIF group had shorter operative time(159.9±27.5min vs 183.8±27.8min, P＜0.05), less intraoperative bleeding(69.6±44.7ml vs 144.8±77.7ml, P＜0.05), and less postoperative drainage volume(91.4±73.6ml vs 168.9±126.2ml, P＜0.05). The VAS scores and ODI of the two groups at each postoperative time point were all significantly improved than those before operation, respectively(P＜0.05), and no significant difference was found between the two groups at the same time point. One year after the operation, the excellent and good rate of modified Macnab criteria was 88% in the UBE-TLIF group and 87% in the W-TLIF group, with no significant difference(P＞0.05). The fusion rate 1 year after operation was 96% in the UBE-TLIF group and 91.3% in the W-TLIF group, with no significant difference between the two groups(P>0.05). The serum CK levels of the two groups of patients at 1 day after surgery increased significantly than those before operation(P<0.05), and there was no statistical difference between the two groups at the same time points(P>0.05), nor was there significant difference in the rate of multifidus muscle atrophy or fat infiltration at same follow-up time points after surgery(P>0.05). The incidence of surgical complications was 8%(2/25) in the UBE-TLIF group and 13%(3/23) in the W-TLIF group, and there was no significant difference between the two groups(P>0.05). There were no revision cases in either group. Conclusions: Both UBE-TLIF and W-TLIF can achieve satisfactory and similar clinical outcomes in the treatment of LDD with similar intervertebral fusion rate and multifidus atrophy rate, while UBE-TLIF had shorter operative time, less intraoperative blood loss and postoperative drainage volume.