Han Qi, Meng Feifan, Chen Ming, Lu Xiangjun, Zhao Deyuan, Wu Dongze, Wang Tingting, Qin Rujie
Department of Orthopedics, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China.
Department of Dermatology, The First People's Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China.
J Pain Res. 2022 Apr 29;15:1271-1282. doi: 10.2147/JPR.S371635. eCollection 2022.
To evaluate the early clinical effect of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery in the treatment of middle-aged and elderly patients with single-level lumbar disc herniation accompanied by lumbar instability.
From January 2019 to June 2020, a total of 82 consecutive patients were categorised into PE-TLIF group and MIS-TLIF group based on different surgical methods. The visual analog scale (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, perioperative objective serological index, operation time, intraoperative blood loss, time to back to work or normal life, and Modified MacNab score were used as the evaluation indexes. The differences between the two groups were analyzed and the clinical effects were compared.
The VAS back pain of PE-TLIF group was decreased compared to that of MIS-TLIF group in the postoperative 1 week and 1 month. The operative time in PE-TLIF group was obviously longer than that in MIS-TLIF group. The hospital stay was significantly shorter in PE-TLIF group than that in MIS-TLIF group. More intraoperative blood loss and postoperative drainage were recorded in MIS-TLIF group. Compared with MIS-TLIF, PE-TLIF surgery was associated with a shorter time to ambulation after surgery and a shorter time to back to work or normal life. Significant statistical differences were observed in IL-6, CRP, and CK on postoperative 3 days between the two groups.
For middle-aged and elderly patients, PE-TLIF and MIS-TLIF surgery both have obvious clinical efficacy and safety. However, with less intraoperative blood loss, shorter recovery time and less injury to the patients, people undergoing PE-TLIF surgery can return to work or normal life faster. It is speculated that PE-TLIF has a higher incidence of complications and recurrence rate than that MIS-TLIF. PE-TLIF may be a better choice for middle-aged and elderly patients with single-level lumbar disc herniation.
评估经皮内镜下经椎间孔腰椎椎间融合术（PE-TLIF）与微创经椎间孔腰椎椎间融合术（MIS-TLIF）治疗中老年单节段腰椎间盘突出症伴腰椎不稳的早期临床效果。
2019年1月至2020年6月，连续纳入82例患者，根据不同手术方式分为PE-TLIF组和MIS-TLIF组。采用视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、日本骨科学会（JOA）评分、围手术期客观血清学指标、手术时间、术中出血量、恢复工作或正常生活时间以及改良MacNab评分作为评估指标。分析两组间差异并比较临床效果。
术后1周和1个月时，PE-TLIF组的VAS背痛评分低于MIS-TLIF组。PE-TLIF组的手术时间明显长于MIS-TLIF组。PE-TLIF组的住院时间明显短于MIS-TLIF组。MIS-TLIF组术中出血量和术后引流量更多。与MIS-TLIF相比，PE-TLIF手术患者术后下床活动时间更短，恢复工作或正常生活时间更短。两组术后3天的IL-6、CRP和CK存在显著统计学差异。
对于中老年患者，PE-TLIF和MIS-TLIF手术均具有明显的临床疗效和安全性。然而，PE-TLIF手术术中出血量少、恢复时间短、对患者损伤小，患者能更快恢复工作或正常生活。推测PE-TLIF的并发症发生率和复发率高于MIS-TLIF。对于中老年单节段腰椎间盘突出症患者，PE-TLIF可能是更好的选择。
