单通道与单侧双通道脊柱内镜下腰椎间融合术治疗单节段腰椎退行性疾病的早期疗效及学习曲线

Early efficacy and learning curve study of Endo-LIF and UBE-LIF in the treatment of single-level lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  单通道脊柱内镜技术  单侧双通道脊柱内镜技术  腰椎后路减压融合术  早期疗效  学习曲线

英文关键词:Lumbar degenerative diseases  Endoscopic lumbar interbody fusion  Unilateral biportal endoscopic lumbar interbody fusion  Lumbar posterior decompression and fusion  Early efficacy  Learning curve

中文摘要:

  【摘要】 目的：比较单通道脊柱内镜下腰椎间融合术（endoscopic lumbar interbody fusion，Endo-LIF）与单侧双通道脊柱内镜下腰椎间融合术（unilateral biportal endoscopic lumbar interbody fusion，UBE-LIF）治疗单节段腰椎退行性疾病（lumbar degenerative diseases，LDD）的早期临床疗效，分析两者的学习曲线。方法：回顾性分析2019年10月~2022年3月在贵州医科大学附属医院骨科开展UBE-LIF术式与Endo-LIF术式治疗的54例单节段LDD患者，其中男26例，女28例；年龄55~71岁（65.0±4.5岁）；手术节段：L3/4 6例，L4/5 29例，L5/S1 19例。根据手术方式，分为A组（Endo-LIF治疗，n=24）和B组（UBE-LIF治疗，n=30）。根据患者接受手术时间的先后顺序，A组前12例为A1组，后12例为A2组；B组前15例为B1组，后15例为B2组。记录手术时间、术后住院时间及并发症，术前、术后3个月、6个月及1年时的腰腿痛视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI），末次随访时的改良Macnab标准评分及融合情况，计算优良率及融合率。通过曲线回归分析方法分析Endo-LIF与UBE-LIF手术时间随手术例数变化趋势。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）。与A2组相比，A1组手术时间较长（P<0.001），但术后住院时间两组间差异无统计学意义（P>0.05）。A组手术时间显著低于B1、B2组（P<0.001），且B1组明显大于B2组（P<0.001）。术后住院时间A组少于B1组（P<0.001），B2组与A组、B1组差异均无统计学意义（P>0.05）。术后A1组1例硬脊膜撕裂、B1组2例硬脊膜撕裂，均保守治疗后症状缓解；B1组1例发生类脊髓高压症，可能与手术时间较长、冲洗盐水刺激等有关，卧床休息后好转。A2与B2组未发生相关并发症。两组术后各时间点腰腿痛VAS评分及ODI较术前均显著改善（P<0.001），评分随时间推移较前下降（P<0.001）。末次随访时A组改良MacNab标准优良率为91.7%（22/24），B组为90.0%（27/30）；A组融合率87.5%，B组融合率90.0%。曲线回归分析示A、B组手术时间分别在12、15例手术后达到相对稳定。结论：Endo-LIF与UBE-LIF治疗LDD是安全有效的。随着手术例数增加两种术式的手术时间逐渐减少，Endo-LIF与UBE-LIF手术时间分别在12、15例手术后趋于稳定。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy of endoscopic lumbar interbody fusion(Endo-LIF) and unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF) in the treatment of single-segment lumbar degenerative diseases(LDD) and analyze the learning curves of both techniques. Methods: Retrospective analysis was conducted on 54 single-segment LDD patients treated with UBE-LIF or Endo-LIF in the Orthopedics Department of Clinical College of Guizhou Medical University from October 2019 to March 2022. There were 26 males and 28 females, aged 65.0±4.5(55-71) years old, and the operative segments were L3/4 in 6 patients, L4/5 in 29 patients, and L5/S1 in 19 patients. The patients were divided into group A(Endo-LIF, n=24) and group B(UBE-LIF, n=30) according to the surgical method, and subdivided into group A1 of the first 12 cases and group A2 of the later 12 cases as well as group B1 of the first 15 cases and group B2 of the later 15 cases in accordance with chronological order. The operative time, postoperative hospital stay, and complications were recorded; Visual analogue scale(VAS) of low back and leg pain and Oswestry disability index(ODI) were collected before operation and at 3 months, 6 months and 1 year after operation; Modified Macnab scores and fusion conditions at final follow-up were observed, and excellent and good rate of modified Macnab criteria and fusion rate were calculated. The trends of changes in operative time with the number of patients of both Endo-LIF and UBE-LIF were analyzed by curve regression analysis. Results: The patients were followed up for 12-14months(12.5±0.7months). Compared with group A2, group A1 had a significantly longer operative time(P<0.001), but there was no significant difference in postoperative hospital stay(P>0.05). The operative time of group A was significantly less that those of groups B1 and B2(P<0.001), and that of group B1 was significantly more than that of group B2(P<0.001). The postoperative hospital stay in group A was less than that in group B1(P<0.001), and there was no significant difference between group B2 and group A or group B1(P>0.05). 1 case of dural tear in group A1 and 2 cases of dural tear occurred in group B1, and the symptoms were relieved after conservative managements; and 1 case of spinal cord hypertension in group B1, which was related to the long operative time and stimulation of saline irrigation, improved after bed rest. No related complications occurred in groups A2 and B2. The postoperative VAS scores of low back and leg pain and ODI were significantly improved when compared with preoperative ones in each group(P<0.001), and they decreased over time(P<0.001). According to the modified MacNab criteria, the excellent and good rate was 91.7%(22/24) in group A and 90.0%(27/30) in group B; The fusion rate was 87.5% in group A and 90.0% in group B. According to the curve regression analysis, the operative time of group A and group B reached relative stability after 12 and 15 cases, respectively. Conclusions: Endo-LIF and UBE-LIF are safe and effective in the treatment of LDD. The operative time of Endo-LIF and UBE-LIF decreased gradually with the increase of the number of cases. Endo-LIF and UBE-LIF are stable in operative time after 12 and 15 cases, respectively.