手术区域全密闭技术在经皮同轴大通道内镜下腰椎融合术治疗退行性腰椎滑脱症中的应用

Clinical efficacy of full surgical area closure technique in percutaneous co-axial large-channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis

中文关键词:  经皮同轴大通道镜下融合  单节段  腰椎滑脱症  手术区域全密闭技术

英文关键词:Percutaneous co-axial large channel endoscopic fusion  Single segment  Lumbar spondylolisthesis  Full surgical area closure technique

中文摘要:

  【摘要】 目的：探讨手术区域全密闭（full surgical area closure technique，FSAC）技术在经皮同轴大通道内镜下腰椎融合术（percutaneous coaxial large-channel endoscopic lumbar interbody fusion，PLE-LIF）治疗退行性腰椎滑脱症中的应用价值。方法：回顾性分析2020年1月~2023年1月因单节段退变性腰椎滑脱症在我院行PLE-LIF的83例患者，其中46例术中采用FSAC技术，纳入FSAC组；37例未采用FSAC技术，纳入N-FSAC组。两组患者性别、年龄、病程及住院时间等一般资料无统计学差异（P>0.05）。两组患者均规律随访1年。记录两组患者手术时间及并发症发生情况。记录两组患者术前1d、术后3d、术后3个月、术后1年的腰痛及下肢痛视觉模拟评分（visual analogue scale，VAS）及术前1d、术后3个月、术后1年的功能障碍指数（Oswestry disability index，ODI）。术后3个月复查腰椎X线片并采用Meyerding分级评估滑脱复位情况，术后1年复查CT并采用Brantigan标准评价两组椎间融合情况。结果：FSAC组手术时间较N-FSAC组更短（118.9±10.6min vs 130.6±16.3min，P<0.05）。两组术后各时间点腰痛和下肢痛VAS评分及ODI均较术前明显下降（P<0.05），两组间同时间点比较均无统计学差异（P>0.05）。N-FSAC组有2例发生下肢麻木，FSAC组无下肢麻木发生；N-FSAC组及FSAC组分别有4例和1例发生神经水肿性疼痛；两组均有1例发生cage移位，两组均无内固定松动、感染及硬膜囊撕裂发生，N-FSAC组术中并发症发生率较FSAC组更高（18.9% vs 4.3%）（P<0.05）。术后1年两组患者的滑脱程度较术前均明显改善（P<0.05），两组间无统计学差异（P>0.05）；FSAC组42例椎间融合成功，N-FSAC组34例椎间融合成功，两组间的融合率（91.3% vs 91.9%）及椎间融合分级比较无统计学差异（P>0.05）。结论：采用FSAC技术的PLE-LIF治疗单节段退变性腰椎滑脱症时，能缩短手术时间，提高手术安全性。

英文摘要:

  【Abstract】 Objectives: To explore the application value of percutaneous co-axial large-channel endoscopic lumbar interbody fusion(PLE-LIF) combined with full surgical area closure technique(FSAC) in the treatment of degenerative lumbar spondylolisthesis. Methods: A retrospective analysis was conducted on 83 patients with single-segment degenerative lumbar spondylolisthesis who underwent PLE-LIF in our hospital from January 2020 to January 2023. Among the patients, 46 received FSAC treatment during operation(FSAC group), and 37 patients did not receive FSAC treatment(N-FSAC group). Both groups of patients were comparable in general information such as gender, age, course of illness, and length of hospital stay(P>0.05). The two groups of patients were followed up for 1 year. The operative time and complications of the two groups of patients were recorded. Both groups of patients were followed up regularly for 1 year. The visual analogue scale(VAS) for low back pain and lower limb pain was recorded on 1d before surgery, 3d after surgery, at 3 months and 1 year after surgery, in addition, the Oswestry disability index(ODI) on 1d before surgery, at 3 months and 1 year after surgery was recorded. X-ray examination was performed at 3 months after operation, and Meyerding grading was used to evaluate the reduction of spondylolisthesis. CT examination was performed at 1 year after operation, and Brantigan criteria were used to evaluate the intervertebral fusion. Results: The operative time in the FSAC group was shorter than that in the N-FSAC group(118.9±10.6min vs 130.6±16.3min, P<0.05). The VAS for low back pain and lower limb pain and ODI at each postoperative time point in the two groups were significantly lower than those before surgery(P<0.05), and there was no statistically significant difference between the two groups at each time point(P>0.05). Two cases of lower limb numbness occurred in the N-FSAC group, while none occurred in the FSAC group; There were 4 cases and 1 case of neuroedema pain in the N-FSAC group and FSAC group, respectively; 1 case in each group respectively had cage displacement, and there was no internal fixation loosening, infection, or dural sac tear in both groups. The incidence rate of intraoperative complications in the N-FSAC group was higher than that in the FSAC group(18.9% vs 4.3%) (P<0.05). One year after surgery, the degree of slippage in both groups of patients improved significantly compared to the conditions before operation(P<0.05), and there was no significant difference between the two groups(P>0.05); Intervertebral fusion occurred in 42 cases in the FSAC group, and 34 cases in the N-FSAC group, and no statistically significant difference was there in the fusion rate(91.3% vs 91.9%) and intervertebral fusion grading between the two groups(P<0.05). Conclusions: PEL-LIF combined with FSAC can shorten the operative time and improve safety in treating single-segment degenerative lumbar spondylolisthesis.