摘要
[目的]比较内镜下经椎间孔入路(endoscopic transforaminal lumbar interbody fusion,E-TLIF)与经腰椎间融合术(en-doscopic interlaminal lumbar interbody fusion,E-ILIF)治疗退行性腰椎滑脱症的临床疗效。[方法]回顾性分析2018年8月—2019年4月在解放军总医院第四医学中心就诊的32例腰椎滑脱症患者的临床资料,术中应用圆柱形可膨胀融合器,根据指征,14例选择E-TLIF术,18例采用E-ILIF术。比较两组围手术期、随访及影像结果。[结果]所有患者均顺利完成手术,无神经根损伤和硬脊膜撕裂,两组手术时间[(121.8±45.1)min vs(129.7±21.5),P=0.388]、切口长度[(5.8±0.2)cm vs(6.2±0.2)cm,P=0.070]、下地行走时间[(44.9±7.8)h vs(42.6±6.3)h,P 0.363]和住院时间[(10.4±2.8)d vs(11.0±2.3)d,P=0.538]的差异均无统计学意义,两组切口均获甲级愈合。所有患者均获随访,随访时间平均(25.8±8.2)个月,随时间推移,两组患者腰痛VAS、腿痛VAS评分及ODI评分均显著减少(P<0.05),相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,术后两组椎间隙高度、腰椎前凸角(L1~L5 Cobb角)均显著增加(P<0.05),相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。与术后6个月相比,末次随访时Mannion融合分级显著改善(P<0.05),两组间椎体融合情况及融合器位置的差异均无统计学意义(P>0.05)。[结论]ETLIF和E-ILIF的临床和影像学结果无明显差异,圆柱形可膨胀融合器可安全应用于这两种内镜下腰椎融合。
[Objective]To compare the clinical outcomes of endoscopic transforaminal lumbar interbody fusion(E-TLIF)versus endoscopic interlaminal lumbar interbody fusion(E-ILIF)for degenerative lumbar spondylolisthesis.[Methods]A retrospective study was conducted on 32 patients who received endoscopic lumbar interbody fusion with cylindrical expandable fusion cage for degenerative lumbar spondylolisthesis in the Fourth Medical Center,General Hospital of PLA from August 2018 to April 2019.According to the indications,ETLIF was performed in 14 cases,while E-ILIF was used in the other18 cases.The documents regarding to perioperative period,follow-up and imaging were compared between the two groups.[Results]All patients in both groups had the operation finished smoothly without nerve root injury or dural tear.There were no significant differences between the two groups in terms of operation time[(121.8±45.1)min vs(129.7±21.5),P=0.388],length of incision,[(5.8±0.2)cm vs(6.2±0.2)cm,P=0.070],postoperative walking time[(44.9±7.8)h vs(42.6±6.3)h,P 0.363]and hospitalization time[(10.4±2.8)d vs(11.0±2.3)d,P 0.538],and all of them in both groups got incisions healed in grade A.With time of follow-up period lasted for an average of(25.8±8.2)months,the VAS scores for lower back pain and leg pain,as well as ODI scores were significantly reduced in both groups(P<0.05),which were not statistically significant between the two groups at any time points accordingly(P>0.05).Radiographically,the intervertebral space height and lumbar lordosis angle(L1~L5 Cobb Angle)significantly increased in both groups after surgery compared with those preoperatively(P<0.05),however,there were no statistically significant differences in the abovesaid imaging parameters between the two groups at corresponding time points(P>0.05).Mannion fusion grade was significantly im-proved in both groups at the last follow-up compared to 6 months after surgery(P<0.05),whereas there were no statistically significant differences in interbody fusion and fusion cage location between the two groups(P>0.05).[Conclusion]There is no significant difference in clinical and imaging consequences between E-TLIF and E-ILIF.The cylindrical expandable fusion cage can safely apply in the two types of endoscopic lumbar fusion.
作者
方鹏飞
王毅
张彦军
张茂虎
闫永海
王金昌
FANG Peng-fei;WANG Yi;ZHANG Yan-jun;ZHANG Mao-hu;YAN Yong-hai;WANG Jin-chang(Orthopedics Department,Baiyin Hospital of Integrated Traditional Chinese and Western Medicine,Baiyin 730900,Gansu,China;Spinal Orthopedics,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,Gansu,China;Orthopedics Department,Traditional Chinese Medicine Hospital of Jingtai County,Baiyin 730400,Gansu,China;Department of Orthopedic Medicine,The Fourth Medical Center,PLA General Hospital,Beijing 100048,China)
出处
《中国矫形外科杂志》
北大核心
2025年第10期885-891,共7页
Orthopedic Journal of China
基金
甘肃省中医药管理局科研项目(编号:GZKP-2020-40)
白银市科技局科研项目(编号:2023-1-55Y)。
关键词
脊柱内镜
经椎间孔入路腰椎椎体间融合术
经椎板间隙入路腰椎椎体间融合术
可膨胀融合器
spinal endoscopy
endoscopic transforaminal lumbar interbody fusion(E-TLIF)
endoscopic interlaminal lumbar inter-body fusion(E-ILIF)
expandable fusion cage
