摘要
[目的]比较双通道脊柱内镜下椎间融合术(biportal endoscopic lumbar interbody fusion,BE-LIF)与传统半椎板切除腰椎椎间融合术(hemilamiectomy and lumbar interbody fusion,HL-LIF)治疗腰椎退行性疾病的临床疗效。[方法]回顾性分析2022年3月—2022年11月在本院手术治疗的腰椎退行性疾病78例患者的临床资料。按照医患沟通结果,35例采用BELIF,41例采用HL-LIF。比较两组围手术期、随访及辅助检查等资料。[结果]虽然BE-LIF组手术时间显著长于HL-LIF组,但BE-LIF组切口长度[(7.1±1.0)cm vs(11.5±2.2)cm,P<0.001]、术中失血量[(240.0±121.2)ml vs(344.9±140.9)ml,P<0.001]、下地时间[(3.2±0.5)d vs(4.4±0.5)d,P<0.001]均显著优于HL-LIF组。平均随访时间(15.8±2.3)个月,随时间推移,两组的VAS、ODI、JOA评分均显著改善(P<0.05)。术后5个月时,BE-LIF组的腰痛VAS[(1.4±0.5)vs(1.8±0.7),P=0.005]、ODI[(15.3±2.5)vs(16.7±3.2),P=0.039]、JOA评分[(25.3±1.0)vs(24.2±1.5),P<0.001]均显著优于HL-LIF组。影像方面,两组术后椎间隙高度、腰椎前凸角度均较术前显著增加(P<0.05)。各时间点两组椎间隙高度、腰椎前凸角、椎间融合Bridwell等级的差异无统计学意义(P>0.05)。[结论]两种术式均取得良好的临床疗效。BE-LIF较HL-LIF手术创伤小,术后早期腰部疼痛轻,功能恢复速度快。
[Objective]To compare clinical efficacy of biportal endoscopic lumbar interbody fusion(BE-LIF)versus conventional hemilamiectomy lumbar interbody fusion(HL-LIF)for degenerative lumbar diseases.[Methods]A retrospective study was done on 78 patients who received surgical treatment for lumbar degenerative diseases in our hospital from March 2022 to November 2022.According to the results of doctor-patient discussion,35 patients received BE-LIF,while other 41 patients underwent HL-LIF.The perioperative period,follow-up and auxiliary examination were compared between the two groups.[Results]Although the BE-LIF cohort consumed significantly longer operative time than the HL-LIF cohort,the former proved significantly superior to the latter in terms of incision length[(7.1±1.0)cm vs(11.5±2.2)cm,P<0.001],intraoperative blood loss[(240.0±121.2)ml vs(344.9±140.9)ml,P<0.001],postoperative walking time[(3.2±0.5)days vs(4.4±0.5)days,P<0.001].With time of the follow-up lasted for(15.8±2.3)months in a mean,the VAS,ODI and JOA scores in both groups significantly improved(P<0.05).The BE-LIF group was significantly better than the HL-LIF group in terms of low back pain VAS[(1.4±0.5)vs(1.8±0.7),P=0.005],ODI[(15.3±2.5)vs(16.7±3.2),P=0.039]and JOA score[(25.3±1.0)vs(24.2±1.5),P<0.001]5 months after surgery.As for imaging,the intervertebral space height and the lumbar lordosis were significantly increased in both groups after surgery(P<0.05).However,there were no significant differences in intervertebral space height,lumbar lordosis and intervertebral fusion Bridwell grade between the two groups at any time points accordingly(P>0.05).[Conclusion]Both of the lumbar fusion methods achieved good clinical outcomes.By comparison,the BE-LIF takes advantage of minimally invasive surgery,with less pain in early stage after operation and faster function recovery over the HL-LIF.
作者
慈吉辰
汲长蛟
张建新
孔鹏
翟钰泽
宫宸
孙昌宇
申素昊
牟海波
CI Ji-chen;JI Chang-jiao;ZHANG Jian-xin;KONG Peng;ZHAI Yu-ze;GONG Chen;SUN Chang-yu;SHEN Su-hao;MOU Hai-bo(The FirstClinical Medical School,Shandong University of Traditional Chinese Medicine,Jinan 250000,China;Department of Minimally InvasiveOrthopedics,Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Jinan 250000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2024年第15期1352-1358,共7页
Orthopedic Journal of China
基金
国家自然科学基金项目(编号:82204876)。
关键词
腰椎退行性疾病
双通道脊柱内镜下椎间融合术
半椎板切除腰椎椎间融合术
lumbar degenerative disease
biportal endoscopic lumbar interbody fusion(BE-LIF)
hemilamiectomy lumbar interbody fusion(HL-LIF)
作者简介
慈吉辰,在读硕士,研究方向:脊柱外科,(电子信箱)19106448031@163.com;通信作者:张建新,(电子信箱)13583189595@163.com。
