经皮内镜下椎间孔腰椎体间融合术治疗腰椎狭窄症的创新术后加速康复：一项前瞻性观察研究。

Enhanced Recovery after an Innovative Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis: A Prospective Observational Study.

机构信息

Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical, Beijing, China.

出版信息

Pain Res Manag. 2021 Dec 20;2021:7921662. doi: 10.1155/2021/7921662. eCollection 2021.

BACKGROUND

The objective of this study was to investigate the enhanced recovery clinical effects of an innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of patients with LSS and degenerative instability.

METHODS

From January 2019 to March 2020, 51 patients with single-segment LSS and degenerative instability were prospectively included in our study (ChiCTR1900020679). The Oswestry Disability Index (ODI), the visual analogue scale (VAS) on lumbar and leg pain (VAS-LBP and VAS-LP), serum creatine kinase (CK), the peak intensity of sulphur hexafluoride microbubble contrast agent (PI), and the maximal cross-sectional area of multifidus muscle (Max-CSA) around the surgical incision were assessed preoperatively, postoperatively, and at regular follow-up.

RESULTS

All patients were followed up. The mean postoperative bedridden time was 20.45 ± 2.66 hours. The ODI, VAS-LBP, and VAS-LP were improved significantly after operation compared to these data before operation in all the patients ( < 0.05). The CK at 1 day after operation was higher compared to the data before the operation ( < 0.05), and there was no significant difference on CK at 1 week after operation ( > 0.05). The PI at 1 week after operation was higher compared to this item before operation ( < 0.05), and there was no significant difference on PI at 1 month or 3 months after operation ( > 0.05). The Max-CSA at 1 week after operation was higher compared to this item before the operation ( < 0.05), and there was no significant difference in Max-CSA at 1 month or 3 months after operation compared with before the operation ( > 0.05).

CONCLUSIONS

Our results and systematic review presented the innovative PE-TLIF technique could obtain satisfactory and effective outcomes for the treatment of patients with LSS and degenerative instability. Our PE-TLIF technique also had the ability to decrease the MF injury and obtain an enhanced recovery.

背景

本研究旨在探讨创新经皮内镜椎间孔腰椎体间融合术（PE-TLIF）治疗单节段腰椎管狭窄症伴退变性不稳患者的加速康复临床效果。

方法

2019 年 1 月至 2020 年 3 月，前瞻性纳入 51 例单节段腰椎管狭窄症伴退变性不稳患者（ChiCTR1900020679）。分别于术前、术后及定期随访时评估患者的腰痛 Oswestry 功能障碍指数（ODI）、腿痛视觉模拟评分（VAS）、血清肌酸激酶（CK）、SF6 微泡造影剂的峰值强度（PI）及手术切口周围多裂肌最大横截面积（Max-CSA）。

结果

所有患者均获得随访，术后平均卧床时间为 20.45±2.66 小时。与术前相比，所有患者术后 ODI、VAS-LBP 和 VAS-LP 均明显改善（<0.05）。术后 1 天 CK 高于术前（<0.05），术后 1 周 CK 与术前相比无差异（>0.05）。术后 1 周 PI 高于术前（<0.05），术后 1 个月和 3 个月 PI 与术前相比无差异（>0.05）。术后 1 周 Max-CSA 高于术前（<0.05），术后 1 个月和 3 个月 Max-CSA 与术前相比无差异（>0.05）。