文章摘要
刘鋆宣,李星晨,徐玉生,等.经皮内镜下与传统后路腰椎融合术治疗单节段退行性腰椎管狭窄症的临床疗效对比.骨科,2022,13(6): 481-487.
经皮内镜下与传统后路腰椎融合术治疗单节段退行性腰椎管狭窄症的临床疗效对比
Clinical Efficacy of Endoscopic Lumbar Interbody Fusion in the Treatment of Single-segment Degenerative Lumbar Spinal Stenosis
投稿时间:2022-09-04  
DOI:10.3969/j.issn.1674-8573.2022.06.001
中文关键词: 腰椎管狭窄症  脊柱内镜  脊柱融合术  对比研究
英文关键词: Lumbar spinal stenosis  Spinal endoscope  Spinal fusion  Comparative study
基金项目:河南省高等学校重点科研项目(18A320010)
作者单位E-mail
刘鋆宣 郑州大学第一附属医院骨科郑州 450000  
李星晨 郑州大学第一附属医院骨科郑州 450000  
徐玉生 郑州大学第一附属医院骨科郑州 450000 ysxu@zzu.edu.cn 
徐远志 郑州大学第一附属医院骨科郑州 450000  
黄泓翰 郑州大学第一附属医院骨科郑州 450000  
陈小鑫 郑州大学第一附属医院骨科郑州 450000  
杨东林 郑州大学第一附属医院骨科郑州 450000  
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中文摘要:
      目的 比较经皮内镜下腰椎椎间融合术(endoscopic lumbar interbody fusion,Endo-LIF)与传统后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗退行性腰椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的临床效果。方法 回顾性分析2019年1月至2020年1月我院收治的74例DLSS病人,根据手术方式分为Endo-LIF组(38例)和PLIF组(36例)。比较两组病人的手术时间、术中出血量等围术期资料。临床评价指标为疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI);影像学评价指标为椎间隙高度、腰椎前凸角及融合率。结果 Endo-LIF组手术时间长于PLIF组,术中出血量、术后卧床时间及住院时间均低于PLIF组,差异有统计学意义(P<0.05)。Endo-LIF组术后1周及3个月的腰痛VAS评分、术后3个月及6个月的ODI均低于PLIF组,差异有统计学意义(P<0.05)。两组病人术后椎间隙高度、腰椎前凸角均较术前改善,差异有统计学意义(P<0.05),但组间差异并无统计学意义(P>0.05)。74例病人随访(30.86±3.46)个月(26~38个月)。术后1年随访时按Birdwell标准评价,两组融合率比较,差异无统计学意义(P>0.05)。Endo-LIF组有2例术后下肢麻木,PLIF组有1例硬膜囊撕裂及1例切口表浅感染。结论 与PLIF相比,采用Endo-LIF治疗DLSS具有创伤小、早期腰痛改善明显、术后功能恢复快等优势,但两者在并发症发生率、融合率等方面并无差异。
英文摘要:
      Objective To compare the clinical efficiency of endoscopic lumbar interbody fusion (Endo-LIF) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of degenerative lumbar spinal stenosis (DLSS). Methods A retrospective analysis on 74 patients with DLSS was conducted from January 2019 to January 2020. According to the surgical method, the patients were divided into Endo-LIF group (38 cases) and PLIF group (36 cases). The operation time, intraoperative blood loss, postoperative bed rest time, hospital stay duration and complications were compared between the groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical efficiency. The fusion rate, disc height (DH) and lumbar lordosis angle (LL) were also measured. Results The operative time in the Endo-LIF group was longer than that in the PLIF group (P<0.05). The intraoperative blood loss was significantly less, postoperative bed rest time and hospital stay duration were significantly shorter in the Endo-LIF group than those in the PLIF group (P<0.05). The VAS score of low back pain in Endo-LIF group was significantly lower than that in PLIF group at 1 week and 3 months after operation (P<0.05). The ODI in Endo-LIF group was significantly lower than that in PLIF group at 3 and 6 months after operation (P<0.05). The DH and LL in two groups were significantly restored after operation (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). 74 patients were followed up for (30.86±3.46) months (26 to 38 months). According to the Birdwell criteria 1 year after operation, the interbody fusion rates showed no significant difference between two groups (P>0.05). For intraoperative and postoperative complications, 2 cases of postoperative lower extremity numbness occurred in the Endo-LIF group. In the PLIF group, there was 1 case of dural tear and 1 case of incision superficial infection. Conclusion Endo-LIF could achieve better clinical outcomes than PLIF in the treatment of DLSS with less trauma and faster postoperative recovery. However, there was no difference between them in complication and fusion rates.
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