1.恩施土家族苗族自治州中心医院 脊柱外科,湖北 恩施 445000;2.重庆大学附属三峡医院 中医科,重庆 404100
1.Department of Spine Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei 445000, China;2.Department of Traditional Chinese Medicine, Three Gorges Hospital of Chongqing University, Chongqing 404100, China
目的 探讨脊柱内镜下经腰椎间孔腰椎椎间融合术（Endo-TLIF）联合膨胀式椎间融合器治疗单节段腰椎退行性疾病的临床效果。方法 收集2019年9月－2021年5月该院收治的单节段腰椎退行性疾病患者73例，根据不同手术方式，分为Endo-TLIF组（32例）和经椎间孔腰椎椎间融合术（TLIF）组（41例），比较两组患者的围手术期资料和临床疗效。结果 Endo-TLIF组手术时间长于TLIF组，术中出血量和术后引流量少于TLIF组，术后卧床时间短于TLIF组（P < 0.05）。两组患者术后腰腿痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）明显低于术前，日本骨科学会（JOA）评分明显高于术前，出院时，Endo-TLIF组腰痛VAS明显低于TLIF组，差异均有统计学意义（P < 0.05）；术后1个月至末次随访时，两组患者腰腿痛VAS比较，差异无统计学意义（P > 0.05）；出院时和术后1个月，Endo-TLIF组JOA评分高于TLIF组，ODI低于TLIF组，差异均有统计学意义（P < 0.05）；术前、术后3个月至末次随访时，两组各时间点JOA评分和ODI比较，差异均无统计学意义（P > 0.05）。结论 传统TLIF和Endo-TLIF治疗单节段腰椎退行性疾病，两者近期临床疗效相当，Endo-TLIF具有出血少和术后恢复快的优势，但手术时间较长。
Objective To investigate the clinical effect of endoscopy-assisted transforaminal lumbar interbody fusion (Endo-TLIF) combined with expandable interbody fusion cage in the treatment of single-segment lumbar degenerative diseases.Methods The data of patients with single-segment lumbar degenerative diseases who underwent surgical treatment from September 2019 to May 2021 were collected. The patients were divided into Endo-TLIF group (32 cases) and transforaminal lumbar interbody fusion (TLIF group) (41 cases) according to the surgical method. The perioperative data and clinical efficacy were compared between the two groups.Results The operation time of Endo-TLIF group was longer than that of TLIF group, the intraoperative blood loss and postoperative wound drainage were less than those of TLIF group, and the postoperative bed rest time was shorter than that of TLIF group (P < 0.05). The visual analogue scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI) of the two groups after operation were significantly lower than those before operation, and the Japanese Orthopaedic Association (JOA) score was significantly higher than that before operation. At discharge, the VAS of low back pain in Endo-TLIF group was significantly lower than that in TLIF group (P < 0.05). There was no significant difference in VAS of low back pain and leg pain between the two groups from 1 month after operation to the last follow-up (P > 0.05). At discharge and 1 month after operation, the JOA score in Endo-TLIF group was higher than that in TLIF group, and the ODI was lower than that in TLIF group, and the differences were statistically significant (P < 0.05). There was no significant difference in JOA score and ODI between the two groups before operation, 3 months after operation to the last follow-up (P > 0.05).Conclusion Compared with traditional TLIF, Endo-TLIF has similar short-term clinical efficacy in the treatment of single-segment lumbar degenerative diseases. Endo-TLIF has the advantages of less bleeding and faster postoperative recovery, but the operation time is longer.