| 全可视化内镜下后外侧经关节突入路腰椎椎间融合术治疗退行性腰椎滑脱症 |
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投稿时间：2024-08-06
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| 作者 | Author | 单位 | Address | E-Mail |
| 熊亮 |
XIONG Liang |
三峡大学第一临床医学院 宜昌市中心人民医院, 湖北 宜昌 443008 |
Department of Spine Surgery, Yichang Central People's Hospital, the First College of Clinical Science, China Three Gorges University, Yichang 443008, Hubei, China |
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| 赵红卫 |
ZHAO Hong-wei |
三峡大学第一临床医学院 宜昌市中心人民医院, 湖北 宜昌 443008 |
Department of Spine Surgery, Yichang Central People's Hospital, the First College of Clinical Science, China Three Gorges University, Yichang 443008, Hubei, China |
ycguke@sina.com |
| 罗茗刈 |
LUO Ming-yi |
三峡大学第一临床医学院 宜昌市中心人民医院, 湖北 宜昌 443008 |
Department of Spine Surgery, Yichang Central People's Hospital, the First College of Clinical Science, China Three Gorges University, Yichang 443008, Hubei, China |
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| 刘丰平 |
LIU Feng-ping |
三峡大学第一临床医学院 宜昌市中心人民医院, 湖北 宜昌 443008 |
Department of Spine Surgery, Yichang Central People's Hospital, the First College of Clinical Science, China Three Gorges University, Yichang 443008, Hubei, China |
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| 卢斌 |
LU Bin |
三峡大学第一临床医学院 宜昌市中心人民医院, 湖北 宜昌 443008 |
Department of Spine Surgery, Yichang Central People's Hospital, the First College of Clinical Science, China Three Gorges University, Yichang 443008, Hubei, China |
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| 邓宇翔 |
DENG Yu-xiang |
三峡大学第一临床医学院 宜昌市中心人民医院, 湖北 宜昌 443008 |
Department of Spine Surgery, Yichang Central People's Hospital, the First College of Clinical Science, China Three Gorges University, Yichang 443008, Hubei, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第12期，第1145-1152页 |
| DOI：10.12200/j.issn.1003-0034.20231116 |
| 基金项目: |
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中文摘要:
目的: 探讨全可视化内镜下后外侧经关节突入路腰椎椎间融合术 (percutaneous endoscopic posterolateral trans-facet lumbar interbody fusion,PE-PTLIF) 治疗退行性腰椎滑脱症(degenerative lumbar spondylolisthesis,DLS)的临床疗效。
方法: 回顾性分析2019年12月至2021年6月采用PE-PTLIF 治疗的 38 例DLS患者的临床资料,男18例,女20例;年龄39~75(60.2±8.9)岁;L3,4 1例,L4,5 23例,L5S1 14例;腰椎滑脱根据Meyerding分度,Ⅰ度29例,Ⅱ度 9例。观察手术时间、术中出血量、引流量、住院时间及并发症情况,分别于术前、术后3 d及术后3、6、12个月采用视觉模拟评分 (visual analogue scale,VAS)评估腰腿疼痛程度,并于术前及术后3、6、12个月采用 Oswestry功能障碍指数(Oswestry disability index,ODI)评价下腰痛功能障碍程度。术后12个月时使用改良MacNab标准评估临床疗效。比较术前和术后12个月硬膜囊横截面积(dural sac cross-sectional area,DSCSA)、椎间隙高度(intervertebral disc height,IDH)、腰椎滑脱率(lumbar spondylolisthesis rate,SR)、腰椎前凸角(lumbar lordosis angle,LL)、手术节段前凸角(segmental lordosis angle,SL);根据Bridwell椎间融合标准评估术后12个月时的椎间融合情况。
结果: 所有患者获得随访,时间13~28 (18.47±4.12)个月。手术时间(181.68±19.34) min,术中出血量(152.87±57.03) ml,引流量(48.18±11.43) ml,术后住院时间(9.45±2.18) d,3例出现并发症。术前、术后3 d及术后3、6、12个月时的腰痛VAS分别为(6.68±1.16)、(4.32±1.13)、(2.18±0.70)、(1.89±0.56)和(1.57±0.72)分;腿痛VAS分别为(6.24±1.42)、(2.95±1.09)、(1.76±0.71)、(1.68±0.74)和(1.26±0.69)分;术前及术后3、6、12个月时的ODI分别为(63.21±11.21)%、(25.24±6.46)%、(20.97±6.26)%和(17.73±5.88)%;术后各时间点腰腿痛VAS、ODI评分均较术前明显降低 (P<0.05)。术后12个月根据改良MacNab标准,优23例,良10例,可3例,差2例。术后12个月DSCSA、IDH、SR、LL和SL分别为(128.32±21.95) mm2、(11.19±1.66) mm、(4.44±2.19)%、(49.32±5.63)°、(9.16±1.90)°,较术前[(58.36±18.11) mm2、(8.19±2.06) mm、(18.43±4.78)%、(42.38±4.94)°和(8.06±2.06)°]均有所改善 (P<0.05)。术后12个月根据Bridwell椎间融合标准,Ⅰ级融合34例,Ⅱ级融合3例,Ⅲ级融合1例。
结论: PE-PTLIF是治疗Ⅰ度和Ⅱ度 DLS有效的方法之一,具有出血少、减压充分、术后恢复快、融合率高等优点,可有效缓解腰腿疼痛、恢复椎间隙高度和改善腰矢状位平衡,是一种安全且微创的手术方式。 |
| 【关键词】全可视化内镜技术 腰椎融合术 退行性腰椎滑脱症 临床疗效 |
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| Degenerative lumbar spondylolisthesis treated by posterolateral transarticular puncture lumbar interbody fusion under full visual endoscopy |
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ABSTRACT
Objective To explore clinical effect of percutaneous endoscopic posterolateral trans-facet lumbar interbody fusion (PE-PTLIF) in treating degenerative lumbar spondylolisthesis.
Methods The data of 38 patients with degenerative lumbar spondylolisthesis treated with PE-PTLIF from December 2019 to June 2021 were retrospectively analyzed,including 18 males and 20 females,aged from 39 to 75 years old with an average of (60.2±8.9) years old;1 patient with L3,4,23 patients with L4,5,14 patients with L5S1;29 patients with degreeⅠand 9 patients with degreeⅡaccording to Meyerding grading. Operative time,intraoperative blood loss,drainage volume,postoperative hospital stay and complcations were observed,visual analogue scale (VAS) was used to evaluate degree of lumbar and leg pain before operation,3 d and 3,6 and 12 months after operation,respectively. Oswestry disability index (ODI) was used to evaluate degree of low back pain dysfunction before operation,3,6 and 12 months after operation. The modified MacNab standard was used to evaluate clinical efficacy at 12 months after operation. Dural sac cross-sectional area (DSCSA),intervertebral disc height (IDH),lumbar spondylolisthesis rate (SR),lumbar lordosis angle (LL) and segmental lordosis angle (SL) were compared before operation and 12 months after operation. Interbody fusion at 12 months was evaluated according to Bridwell intervertebral fusion standard.
Results All patients were followed up for 13 to 28 months with an average of (18.47±4.12) months. The operative time was (181.68±19.34) min,intraoperative blood loss was (152.87±57.03) ml,drainage volume was (48.18±11.43) ml,and postoperative hospital stay was (9.45±2.18) d and 3 patients occurred complications. VAS of lumbar pain before operation,3 days,3,6 and 12 months after operation were (6.68±1.16),(4.32±1.13),(2.18±0.70),(1.89±0.56) and (1.57±0.72),respectively. VAS of leg pain were (6.24±1.42),(2.95±1.09),(1.76±0.71),(1.68±0.74) and (1.26±0.69) respectively. Preoperative and postoperative 3,6 and 12 months of ODI were (63.21±11.21)%,(25.24±6.46)%,(20.97±6.26)% and (17.73±5.88)%,respectively. Postoperative VAS of lumbar and leg pain and ODI were significantly lower than those of preoperative time points (P<0.05). According to the modified MacNab standard,23 patients got excellent result,10 good,3 fair,and 2 poor at 12 months after operation. Postoperative DSCSA,IDH,SR,LL and SL at 12 months were (128.32±21.95) mm2,(11.19±1.66) mm,(4.44±2.19)%,(49.32±5.63)°,(9.16±1.90)°,respectively,and were improved compared with preoperative[(58.36±18.11) mm2,(8.19±2.06) mm (18.43±4.78)%,(42.38±4.94) ° and (8.06±2.06) °] (P<0.05). Thirty-four patients obtained gradeⅠfusion,3 patients woth gradⅡfusion and 1 patient with grade Ⅲ fusion at 12 months after operation according to Bridwell intervertebral fusion standard.
Conclusion PE-PTLIF could provide effective method for the treatment of gradeⅠand gradeⅡdegenerative lumbar spondylolisthesis. It has advantages of less bleeding,sufficient decompression,fast postoperative recovery and high fusion rate,which could effectively relieve lumbar and leg pain,restore vertebral space height and improve lumbar sagittal balance. PE-PTLIF is a safe and minimally invasive surgery. |
| KEY WORDS Full endoscopy Lumbar interbody fusion Degenerative lumbar spondylolisthesis Clinical efficacy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 熊亮,赵红卫,罗茗刈,刘丰平,卢斌,邓宇翔.全可视化内镜下后外侧经关节突入路腰椎椎间融合术治疗退行性腰椎滑脱症[J].中国骨伤,2024,37(12):1145~1152 |
| 英文格式: | XIONG Liang,ZHAO Hong-wei,LUO Ming-yi,LIU Feng-ping,LU Bin,DENG Yu-xiang.Degenerative lumbar spondylolisthesis treated by posterolateral transarticular puncture lumbar interbody fusion under full visual endoscopy[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1145~1152 |
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