大通道全内镜下椎间减压融合单侧与双侧椎弓根螺钉内固定治疗腰椎退行性疾病的疗效比较

Comparison of the efficacies of large channel full-endoscopic intervertebral decompression and fusion with unilateral and bilateral pedicle screw fixations for lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  减压融合内固定术  椎弓根螺钉固定  单侧/双侧  大通道全内镜下手术

英文关键词:Lumbar degenerative diseases  Decompression fusion and internal fixation  Pedicle screw fixation  Unilateral/bilateral  Large channel full-endoscopic technique

中文摘要:

  【摘要】 目的：比较大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病的疗效。方法：回顾性分析2019年12月~2021年10月在我院行大通道全内镜下椎间减压融合内固定手术治疗的47例单节段腰椎退行性疾病患者的临床资料，其中20例采用单侧椎弓根螺钉固定（单侧固定组），男5例，女15例，年龄39~69岁（54.1±9.6岁）；27例采用双侧椎弓根螺钉固定（双侧固定组），男9例，女18例，年龄40~70岁（57.8±9.4岁）。两组患者的年龄、体重指数（body mass index，BMI）、性别、手术节段、疾病类型、随访时间等一般资料均无统计学差异（P>0.05）。比较两组患者手术时间、术中透视次数、住院费用、住院时间、手术前后的血红蛋白及变化值和并发症发生率；术前及术后3天、3个月、1年采用疼痛视觉模拟评分（visual analog scale，VAS）评价腰腿痛，术前及术后3个月、1年采用Oswestry功能障碍指数（Oswestry disability index，ODI）评价功能障碍情况；术后1年根据CT评价椎间融合情况，通过改良MacNab标准对临床疗效进行评价。结果：所有患者手术顺利，均获得1年及以上随访，双侧固定组手术时间、术中透视次数、住院费用、住院时间均显著性高于单侧固定组（P<0.05）。两组患者术前、术后血红蛋白值及血红蛋白变化值均无统计学差异（P>0.05）。两组患者术后3天、3个月、1年的VAS评分及术后3个月、1年的ODI均较术前明显下降（P<0.05）；两组同时间点VAS评分及ODI比较均无统计学差异（P>0.05）。两组并发症发生率（单侧固定组10.0% vs 双侧固定组11.1%）、术后1年融合率（单侧固定组90.0% vs 双侧固定组92.6%）及改良MacNab优良率（单侧固定组90.0% vs 双侧固定组88.9%）均无统计学差异（P>0.05）。结论：大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病均安全有效，与双侧固定相比，单侧固定术中透视次数、手术时间、住院费用、住院时间更具有优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of large channel full-endoscopic intervertebral decompression and fusion with unilateral pedicle screw fixation and bilateral pedicle screw fixation in the treatment of single-segment lumbar degenerative diseases(LDD). Methods: The clinical data of 47 patients with single-segment LDD treated with intervertebral decompression, fusion and internal fixation in our hospital from December 2019 to October 2021 were retrospectively analyzed. Among the patients, 20 received unilateral pedicle screw fixation(unilateral fixation group), including 5 males and 15 females, aged 39-69 years(54.1±9.6 years); The other 27 were treated with bilateral pedicle screw fixation(bilateral fixation group), including 9 males and 18 females, aged 40-70 years(57.8±9.4 years). There were no statistical differences between the two groups in terms of age, body mass index(BMI), gender, follow-up time, operative segment, and type of diseases(P>0.05). The operative time, number of intraoperative fluoroscopies, hospitalization expenses, length of hospital stay, pre- and post-operative hemoglobin values and changes, and complications were compared between the two groups; The low back and leg pains were evaluated with visual analog scale(VAS) before operation and at 3d, 3 months and 1 year after operation and function disabilites were assessed with Oswestry disability index(ODI) at 3 months and 1 year after operation. The intervertebral fusion was evaluated with CT at 1 year after surgery and the clinical outcomes were assessed by the modified MacNab criteria. Results: The patients were followed up for 1 year and above. The operative time, number of intraoperative fluoroscopies, hospitalization expenses, and length of hospital stay were significantly higher in the bilateral fixation group than those in the unilateral fixation group(P<0.05), while no statistically significant difference was found in the pre- and post-operative hemoglobin values and changess between the two groups(P>0.05). The VAS scores at 3d, 3 months and 1 year postoperatively and ODI at 3 months and 1 year postoperatively were significantly lower in both groups than before surgery(P<0.05), while no statistical difference was found between the two groups in VAS scores and ODI at the same postoperative time points, respectively(P>0.05). The unilateral fixation group was not statistically different from the bilateral fixation group in the incidence of complications(10.0% vs 11.1%), fusion rate(90.0% vs 92.6%) and modified MacNab excellent and good rate(90.0% vs 88.9%) at 1 year after surgery(P>0.05). Conclusions: Large channel full-endoscopic intervertebral decompression and fusion with unilateral pedicle screw fixation and bilateral pedicle screw fixation are both safe and effective in the treatment of single-segment LDD, and unilateral fixation is superior in the number of intraoperative fluoroscopies, hospitalization expenses, operative time, and length of hospital stay.