腰椎内镜下单侧椎板切开双侧减压术与微创经椎间孔腰椎椎体间融合术治疗单节段腰椎管狭窄症的比较

Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis.

作者信息

Hua Wenbin, Wang Bingjin, Ke Wencan, Wu Xinghuo, Zhang Yukun, Li Shuai, Yang Shuhua, Yang Cao

机构信息

Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.

出版信息

BMC Musculoskelet Disord. 2020 Nov 27;21(1):785. doi: 10.1186/s12891-020-03820-2.

DOI:10.1186/s12891-020-03820-2

PMID:33246434

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7697381/

Abstract

BACKGROUND

The aim of the present study is to compare the clinical outcomes and postoperative complications of lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) to treat one-level lumbar spinal stenosis (LSS) without degenerative spondylolisthesis or deformity.

METHODS

A retrospective analysis of 112 consecutive patients of one-level LSS undergoing either LE-ULBD or MIS-TLIF was performed. Patient demographics, operation time, estimated blood loss, time to ambulation, length of hospitalization, intraoperative and postoperative complications were recorded. The visual analog scale (VAS) score for leg and back pain, the Oswestry Disability Index (ODI) score, and the Macnab criteria were used to evaluate the clinical outcomes. The healthcare cost was also recorded.

RESULTS

The operation time, estimated blood loss, time to ambulation and length of hospitalization of LE-ULBD group were shorter than MIS-TLIF group. The postoperative mean VAS and ODI scores decreased significantly in both groups. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 90.6 and 93.8% in the two groups. The mean VAS scores, ODI scores and outcomes of the modified Macnab criteria of both groups were of no significant difference. The healthcare cost of LE-ULBD group was lower than MIS-TLIF group. Two cases of intraoperative epineurium injury were observed in the LE-ULBD group. One case of cauda equina injury was observed in the LE-ULBD group. No nerve injury, dural injury or cauda equina syndrome was observed in MIS-TLIF group. However, one case with transient urinary retention, one case with pleural effusion, one case with incision infection and one case with implant dislodgement were observed in MIS-TLIF group.

CONCLUSIONS

Both LE-ULBD and MIS-TLIF are safe and effective to treat one-level LSS without degenerative spondylolisthesis or deformity. LE-ULBD is a more minimally invasive option and of less economic burden compared with MIS-TLIF. Decompression plus instrumented fusion may be not necessary for one-level LSS without degenerative spondylolisthesis or deformity.

摘要

背景

本研究旨在比较腰椎内镜下单侧椎板切开双侧减压术（LE-ULBD）与微创经椎间孔腰椎椎间融合术（MIS-TLIF）治疗无退行性椎体滑脱或畸形的单节段腰椎管狭窄症（LSS）的临床疗效和术后并发症。

方法

对112例连续接受LE-ULBD或MIS-TLIF治疗的单节段LSS患者进行回顾性分析。记录患者的人口统计学资料、手术时间、估计失血量、下床活动时间、住院时间、术中及术后并发症。采用视觉模拟量表（VAS）评估腿痛和背痛评分、Oswestry功能障碍指数（ODI）评分以及Macnab标准来评估临床疗效。同时记录医疗费用。

结果

LE-ULBD组的手术时间、估计失血量、下床活动时间和住院时间均短于MIS-TLIF组。两组术后平均VAS和ODI评分均显著降低。根据改良Macnab标准，两组的优良率分别为90.6%和93.8%。两组的平均VAS评分、ODI评分及改良Macnab标准的疗效差异均无统计学意义。LE-ULBD组的医疗费用低于MIS-TLIF组。LE-ULBD组观察到2例术中神经外膜损伤。LE-ULBD组观察到1例马尾神经损伤。MIS-TLIF组未观察到神经损伤、硬脊膜损伤或马尾神经综合征。然而，MIS-TLIF组观察到1例短暂性尿潴留、1例胸腔积液、1例切口感染和1例植入物移位。