内镜下腰椎间融合术与开放后路腰椎间融合术治疗L4~S1双节段腰椎退行性疾病的临床疗效和影像学参数对比

Comparison of clinical outcomes and imaging parameters between Endo-LIF and PLIF in the treatment of L4-S1 lumbar degenerative diseases

中文关键词:  双节段腰椎退行性疾病  内镜下腰椎间融合术  后路腰椎间融合术  临床疗效  影像学

英文关键词:Double-segment lumbar degenerative disease  Endoscopic lumbar interbody fusion  Posterior lumbar interbody fusion  Clinical outcomes  Imaging

中文摘要:

  【摘要】 目的：比较内镜下腰椎间融合术（endoscopic lumbar interbody fusion，Endo-LIF）与传统开放后路腰椎间融合术（posterior lumbar interbody fusion，PLIF）治疗L4~S1双节段腰椎退行性疾病（lumbar degenerative disease，LDD）的临床疗效及影像学参数。方法：回顾性分析2020年6月~2023年6月L4~S1双节段LDD接受Endo-LIF或PLIF治疗患者，其中接受Endo-LIF治疗患者24例，纳入Endo-LIF组（61.58±8.74岁，随访30.74±7.62个月）；采用1∶1倾向性评分匹配（propensity score matching，PSM）获得24例PLIF手术患者，纳入PLIF组（62.33±8.95岁，随访30.70±5.48个月）。两组患者间年龄、性别、体质指数（body mass index，BMI）、随访时长和临床诊断无统计学差异（P>0.05）。记录并比较两组患者围手术期指标（手术时间、术中出血量和住院时间）；比较两组患者术前及术后3d、术后6个月和末次随访时的临床情况，包括腰、腿痛视觉模拟量表（visual analogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分，术后3d和末次随访时的影像学参数（腰椎前凸角、手术节段前凸角、椎间隙高度、椎管矢状径）；记录并比较两组患者末次随访时的椎间融合率及术后并发症。结果：Endo-LIF组术中出血量少于PLIF组[90（50，200）mL vs 200（177.5，300）mL，P＜0.05]，住院天数短于PLIF组[10（8.25，12）d vs 12（11，16.5）d，P＜0.05]，手术时间长于PLIF组（259.29±35.10min vs 227.71±36.60min，P＜0.05）。临床疗效方面，两组术后3d、术后6个月和末次随访时的腰腿痛VAS评分、ODI及JOA评分均较术前显著性改善（P＜0.05）。术后6个月时Endo-LIF组腰痛VAS评分较PLIF组更低（2.08±0.88分 vs 2.67±0.64分，P＜0.05）；术后6个月及末次随访时Endo-LIF组ODI优于PLIF组（P＜0.05），两组腿痛VAS评分及JOA评分在各时间点均不存在显著性差异（P＞0.05）。影像学参数中，术后3d及末次随访时，两组各节段的椎间隙高度和椎管矢状径均较术前改善（P＜0.05），且两组间比较不存在显著性差异（P＞0.05）；Endo-LIF组术后3d节段前凸角大于术前及末次随访（P＜0.05），PLIF组术后3d较术前改善（P＜0.05），且Endo-LIF组末次随访时节段前凸角显著性小于PLIF组（24.65°±6.40° vs 28.03°±3.05°，P＜0.05）；两组内和两组间的腰椎前凸角对比在各时间段均无显著性差异（P＞0.05）。Endo-LIF组和PLIF组的融合率和术后并发症发生率无明显差异（P＞0.05）。结论：Endo-LIF治疗L4~S1双节段LDD可获得与PLIF相当的临床获益，但其在手术节段前凸角度的恢复效能上不及PLIF。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy and imaging parameters of endoscopic lumbar interbody fusion(Endo-LIF) with posterior lumbar interbody fusion(PLIF) in the treatment of L4-S1 double-segment lumbar degenerative disease(LDD). Methods: A retrospective study was performed on patients with L4-S1 LDD treated with Endo-LIF or PLIF between June 2020 and June 2023. 24 patients received Endo-LIF was enrolled in the Endo-LIF group(61.58±8.74 years, follow-up of 30.74±7.62 months); 24 patients treated with PLIF matched in a 1∶1 ratio using propensity score matching(PSM) were included in the PLIF group(62.33±8.95 years, follow-up of 30.70±5.48 months). There was no statistical difference between the two groups in baseline data, such as age, gender, body mass index(BMI), follow-up period, as well as clinical diagnosis(P>0.05). Perioperative indicators(operative time, intraoperative blood loss, hospital stay) were recorded and compared between the two groups; Clinical conditions before operation, at postoperative 3d, 6 months and final follow-up, including low back and leg pain visual analogue scale(VAS) score, Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) score, as well as postoperative 3d and final follow-up imaging parameters, such as lumbar lordosis(LL), segmental lordosis(SL) of operated segment, average disc height(ADH), and sagittal diameter of spinal canal(SD) were compared; The interbody fusion rate at final follow-up and postoperative complications were also compared. Results: Endo-LIF group was less in intraoperative blood loss[90(50, 200)mL vs 200(177.5, 300)mL, P＜0.05], shorter in hospital stay[10(8.25, 12)d vs 12(11, 16.5)d, P＜0.05], but longer in operative time than the PLIF group(259.29±35.10min vs 227.71±36.60min, P＜0.05). Both groups showed significant improvement in the low back pain and leg pain VAS scores, ODI and JOA scores at all postoperative time points compared with baseline(P＜0.05). Endo-LIF group was lower in low back pain VAS score than PLIF group(2.08±0.88 points vs 2.67±0.64 points, P＜0.05) at 6-month follow-up, and also lower in ODI at 6-month and final follow-up(P＜0.05). No significant differences were found in leg pain VAS score and JOA score between the two groups at any postoperative time point(P＞0.05). Both groups showed improved ADH and SD at postoperative 3d and final follow-up compared with baseline(P＜0.05), while there was no significant difference between groups(P＞0.05). In Endo-LIF group, postoperative 3d SL was bigger than baseline and final follow-up（P＜0.05）, while in PLIF group postoperative 3d SL was bigger than baseline(P＜0.05), and SL was smaller in Endo-LIF group at final follow-up(24.65°±6.40° vs 28.03°±3.05°, P＜0.05). The LL wasn′t significantly different in intragroup and intergroup comparisons(P＞0.05). No differences in rates of fusion or complication between groups(P>0.05). Conclusions: Endo-LIF yields comparable clinical benefits to PLIF in the treatment of L4-S1 LDD, whereas its efficacy in restoring SL was inferior to that of PLIF.