不同方法治疗腰椎退行性病变的对比研究

Comparative study of different treatment methods for lumbar disc degenerative change

摘要:

目的 探讨单侧双通道内镜下经椎间孔腰椎间融合术（UBE-TLIF）、微创通道下经椎间孔腰椎间融合术（MIS-TLIF）和后路腰椎椎间融合术（PLIF）治疗腰椎退行性病变的疗效和安全性。方法 回顾性分析2019年1月－2022年12月该院101例接受手术治疗的腰椎退行性病变患者的临床资料，按手术不同方法，将患者分为UBE-TLIF组（37例）、MIS-TLIF组（33例）和PLIF组（31例）。比较3组患者手术相关指标、视觉模拟评分法（VAS）评分、腰椎功能障碍和并发症发生情况。手术前后测量患者手术节段椎间隙高度，以及腰椎前凸角。术后12个月运用Bridwell标准评价患者椎间融合情况。结果 UBE-TLIF组手术时间明显长于MIS-TLIF组和PLIF组，且MIS-TLIF组明显长于PLIF组，差异均有统计学意义（P < 0.05）；UBE-TLIF组术中出血量和术后引流量明显少于MIS-TLIF组和PLIF组，且MIS-TLIF组明显少于PLIF组，UBE-TLIF组术后住院时间明显短于MIS-TLIF组和PLIF组，且MIS-TLIF组明显短于PLIF组，差异均有统计学意义（P < 0.05）；3组患者术后1、3和12个月的腰、腿痛VAS评分明显低于术前，UBE-TLIF组术后1和3个月的腰、腿痛VAS评分明显低于MIS-TLIF组和PLIF组，且MIS-TLIF组明显低于PLIF组，差异均有统计学意义（P < 0.05）；3组患者术后1、3和12个月的Oswestry功能障碍指数（ODI）明显低于术前，UBE-TLIF组术后1个月的ODI明显低于MIS-TLIF组和PLIF组，差异均有统计学意义（P < 0.05）；3组患者术后1、3和12个月的椎间隙高度和腰椎前凸角明显大于术前，差异均有统计学意义（P < 0.05）；UBE-TLIF组、MIS-TLIF组和PLIF组术后12个月椎间融合率分别为94.59%、93.94%和93.55%，3组患者比较，差异无统计学意义（P > 0.05）；UBE-TLIF组和MIS-TLIF组椎间融合时间明显短于PLIF组，差异均有统计学意义（P < 0.05）；3组患者并发症发生率比较，差异无统计学意义（P > 0.05）。结论 UBE-TLIF、MIS-TLIF和PLIF治疗腰椎退行性病变，均能取得较高的融合率，但UBE-TLIF和MIS-TLIF手术创伤更小，且UBE-TLIF的手术创伤较MIS-TLIF更小，术后恢复更快。

Abstract:

Objective To investigate the efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and posterior lumbar interbody fusion (PLIF) in patients with lumbar disc degenerative change.Methods The medical records of 101 patients with lumbar disc degenerative change who underwent surgical treatment in our hospital from January 2019 to December 2022 were retrospectively collected, and they were divided into UBE-TLIF group (37 cases), MIS-TLIF group (33 cases) and PLIF group (31 cases) according to types of operation. The operation related indexes, visual analogue scale (VAS), dysfunction and postoperative complications of the three groups were compared. The height of the intervertebral space and the lumbar lordosis angle were measured before and after surgery. Interbody fusion 12 months after surgery were evaluated via Bridwell criteria.Results The duration of operation of UBE-TLIF group was significantly longer than that of MIS-TLIF group and PLIF group, and MIS-TLIF group was significantly longer than that of PLIF group, the differences were statistically significant (P < 0.05); The intraoperative blood loss and postoperative drainage volume in the UBE-TLIF group were significantly less than those in the MIS-TLIF group and PLIF group, and the MIS-TLIF group was significantly less than that in the PLIF group, the postoperative hospital stay in the UBE-TLIF group was significantly shorter than that in the MIS-TLIF group and PLIF group, and the MIS-TLIF group was significantly shorter than that in the PLIF group, the differences were statistically significant (P < 0.05); The VAS of low back pain and leg pain at 1, 3, and 12 months after operation in the 3 groups were significantly lower than those before operation (P < 0.05); The VAS of low back pain and leg pain at 1 and 3 months after operation in the UBE-TLIF group was significantly lower than that in the MIS-TLIF group and the PLIF group, and the VAS of low back pain and leg pain in the MIS-TLIF group was significantly lower than that in the PLIF group (P < 0.05); The Oswestry disability index (ODI) at 1, 3 and 12 months after operation in the 3 groups was significantly lower than that before operation, and the ODI in UBE-TLIF group was significantly lower than that in MIS-TLIF group and PLIF group at 1 month after operation, the differences were statistically significant (P < 0.05); The intervertebral space height and lumbar lordosis angle at 1, 3, and 12 months after operation were significantly bigger than those before operation in 3 groups (P < 0.05); At 12 months after operation, the intervertebral fusion rates of UBE-TLIF group, MIS-TLIF group and PLIF group were 94.59%, 93.94% and 93.55%, respectively, showing no significant difference among the 3 groups (P > 0.05); The interbody fusion time in UBE-TLIF group and MIS-TLIF group was significantly shorter than that in PLIF group (P < 0.05); There was no significant difference in the incidence of complications among the three groups (P > 0.05).Conclusion UBE-TLIF, MIS-TLIF and PLIF can all achieve a higher interbody fusion rate in treating lumbar disc degenerative change, and UBE-TLIF and MIS-TLIF cause less serious surgical trauma, while UBE-TLIF outperforms MIS-TLIF in respect of surgical trauma, and sees faster postoperative recovery.