摘要
目的:对比分析单侧双通道内镜下经椎间孔减压椎间融合术(unilateral biportal endoscopic transforami-nal lumbar interbody fusion,UBE-TLIF)与椎旁肌间隙(Wiltse)入路经椎间孔减压椎间融合术(transforaminal lumbar interbody fusion via Wiltse approach,W-TLIF)治疗腰椎退行性疾病的疗效及多裂肌损伤情况.方法:回顾性分析2020年1月~2021年2月于我院接受经椎间孔减压融合手术的48例腰椎退行性疾病患者的临床资料.根据手术方式将患者分为UBE-TLIF组(n=25)和W-TLIF组(n=23).UBE-TLIF组男性9例,女性16例,年龄62.1±12.7岁;W-TLIF组男性11例,女性12例,年龄58.7±14.3岁.比较两组手术时间、术中出血量、术后引流量及术后住院天数,术前和术后1天、3个月、6个月、1年时的腰腿痛视觉模拟评分(visual analogue scales,VAS)及术前和术后3个月、6个月、1年时的Oswestry功能障碍指数(Oswestry disability index,ODI).术后1年采用改良Macnab标准评估临床疗效,采用Bridwell标准评估植骨融合情况.比较术前、术后1天的血清肌酸激酶(creatine kinase,CK)水平,测量并计算术后3个月、6个月、1年时多裂肌的萎缩率和脂肪浸润率,评估多裂肌损伤情况.统计并分析两组手术并发症及翻修情况.结果:所有患者顺利完成手术.与W-TLIF组比较,UBE-TLIF组手术时间更短(159.9±27.5min vs 183.8±27.8min,P<0.05),术中出血量更少(69.6±44.7ml vs 144.8±77.7ml,P<0.05),术后引流量更少(91.4±73.6ml vs 168.9±126.2ml,P<0.05).两组患者术后各时间点的腰腿痛VAS评分及ODI与术前比较均有显著性改善(P<0.05),两组同时间点比较均无显著性差异(P>0.05).术后1年UBE-TLIF组改良Macnab标准优良率为88%,W-TLIF组为87%,两组无统计学差异(P>0.05).术后1年UBE-TLIF组融合率为96%,W-TLIF组为91.3%,两组无统计学差异(P>0.05).术后1天两组患者血清CK水平较术前显著性升高(P<0.05),两组同时间点比较无统计学差异(P>0.05);两组患者术后相同随访
Objectives:To compare and analyze the clinical outcomes and postoperative multifidus injury conditions between unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF)and transforaminal lumbar interbody fusion via the Wiltse approach(W-TLIF)in the treatment of lumbar degenerative disease(LDD).Methods:A retrospective analysis was performed on 48 patients with LDD treated with transforaminal lumbar interbody fusion between January 2020 and February 2021 in our hospital.The patients were divided into the UBE-TLIF group(n=25)and the W-TLIF group(n=23)according to different surgical methods.The UBE-TLIF group consisted of 9 males and 16 females,with an average age of 62.1±12.7 years,while the W-TLIF group consisted of 11 males and 12 females,with an average age of 58.7±14.3 years.The operative time,intraoperative bleeding,postoperative drainage volume,and postoperative hospital stay were compared between the two groups,as well as the visual analogue scale(VAS)for low back and leg pain before surgery,at 1 day,3 and 6 months,and 1 year after surgery,and Oswestry disability index(ODI)before surgery,at 3 and 6 months,and 1 year after surgery.Modified Macnab criteria were employed to evaluate the clinical efficacy and the Bridwell criteria were used to evaluate the bone graft fusion at one year after surgery.Serum creatine kinase(CK)levels were compared between pre-operation and 1 day after operation,and the atrophy rate and fat infiltration of multifidus muscle were measured and calculated at 3 months,6 months,and 1 year after operation to evaluate the injury of multifidus muscle.Surgical complications and revision rates were counted and anlyzed between the two groups.Results:The surgery went uneventfully in all the patients.Comparing with the W-TLIF group,the UBE-TLIF group had shorter operative time(159.9+27.5min vs 183.8±27.8min,P<0.05),less intraoperative bleeding(69.6±44.7ml vs 144.8±77.7ml,P<0.05),and less postoperative drainage volume(91.4±73.6ml vs 168.9±126.2ml,P<0.05).The VAS scores
作者
段琪飞
黄帅豪
梁国彦
庄见雄
郑晓青
昌耘冰
DUAN Qifei;HUANG Shuaihao;LIANG Guoyan(Spine Surgery Department,Guangdong Provincial People's Hospital Affiliated to Southern Medical University(Guangdong Academy of Medical Sciences),Guangzhou,510080,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2023年第1期27-36,共10页
Chinese Journal of Spine and Spinal Cord
基金
广州市科技计划项目(202103000053)。
