V形双通道脊柱内镜系统辅助下腰椎椎间融合术治疗单节段腰椎疾病的疗效分析

Analysis of curative effect of V-shape bichannel endoscopy(VBE) system assisted lumbar interbody fusion in the treatment of single level lumbar spine diseases

中文关键词:  脊柱微创手术  脊柱内镜  腰椎椎间融合

英文关键词:Minimally invasive spinal surgery  Spinal endoscopy  Lumbar intervertebral fusion

中文摘要:

  【摘要】 目的：探讨V形双通道脊柱内镜（VBE）系统辅助下经椎间孔入路腰椎椎间融合手术（VBE-TLIF）的初步临床应用效果。方法：回顾性分析2020年1月~2021年4月，因单节段腰椎疾病于我院接受VBE-TLIF手术治疗的20例患者的临床资料。其中男性13例，女性7例，年龄28~77岁，平均57.0±11.7岁。记录手术时间及并发症发生情况，于术前及术后3d、3个月、6个月、12个月、18个月时评估患者腰腿痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI），评估症状缓解情况。分析末次随访时改良MacNab评分、影像学资料等，评估手术优良率及融合率。结果：20例患者术后平均随访27.0±3.6个月（24～36个月），症状均得到明显改善。患者平均术前下肢痛VAS评分6.3±1.6分，腰痛VAS评分5.7±1.1分；术后3d下肢痛VAS评分1.9±0.9分，腰痛VAS评分2.3±0.8分；术后18个月下肢痛VAS评分0.7±0.6分，腰痛VAS评分0.9±0.7分，疼痛明显改善，差异有统计学意义（P＜0.05）。术后18个月ODI为（15.0±5.8）％，较术前[（60.2±15.3）％]明显改善，差异有统计学意义（P＜0.05）。术后出现屈髋乏力1例，经对症治疗1个月后改善；1例出现融合器移位伴神经根激惹症状，二次手术翻修，融合率为95%（19/20）；无严重手术相关并发症出现，根据改良MacNab标准，优良率达95%。结论：VBE-TLIF是安全有效的腰椎微创融合技术方法，初步临床应用效果较为满意。

英文摘要:

  【Abstract】 Objectives: To report a V-shape bichannel endoscopy (VBE) system and evaluate the preliminary clinical effects of VBE assisted transforaminal lumbar interbody fusion(VBE-TLIF). Methods: 20 patients with lumbar diseases underwent VBE-TLIF surgery in our hospital from January 2020 to April 2021 were retrospectively reviewed. There were 13 males and 7 females, with a mean age of 57.0±11.7 years old(28-77 years old). The operative time and complications were collected, and visual analogue scale(VAS) scores, Oswestry disability index(ODI) before surgery and at 3d, 3, 6, 12 and 18 months after surgery were recorded to evaluate the relief of patients′ symptoms. And also, modified MacNab′s criteria and radiological examination results at final follow-up were analyzed to to evaluate the overall satisfactory and fusion rate. Results: The average follow-up time of 20 patients was 27.0±3.6 months(22-36 months), and the clinical symptoms of patients relieved significantly. The average VAS leg pain score and VAS back pain score reduced respectively from 6.3±1.6 and 5.7±1.1 before operation to 1.9±0.9 and 2.3±0.8 at 3d postoperatively, and further to 0.7±0.6 and 0.9±0.7 at 18 months after the surgery, and both with significant differences(P＜0.05). Comparing with the preoperative average ODI[(60.2±15.3)％], the ODI at the 18th month after surgery was (15.0±5.8)%, and the difference was with statistical significance(P＜0.05). There was one patient experienced transient hip flexion weakness and improved after one month of symptomatic treatment; One patient experienced cage immigration causing nerve root irritation and underwent reoperation, the fusion rate was 95%(19/20); No serious operation related complications occurred. The overall excellent and good rate was 95% by modified MacNab′s criteria. Conclusions: VBE-TLIF is a safe and effective minimally invasive lumbar fusion technique, and its primary clinical application is satisfactory in outcomes.