经皮内镜后路腰椎间融合术治疗1度腰椎滑脱
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1.郑州大学第一附属医院骨科;2.周口骨科医院骨科

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河南省高等学校重点科研项目(编号: 20A320019)


Percutaneous endoscopic posterior lumbar interbody fusion vs minimally invasive transforaminal lumbar interbody fusion for grade 1 lumbar spondylolisthesis
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1.Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University;2.Department of Orthopedics, Zhoukou Osteological Hospital

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    摘要:

    [目的]比较经皮内镜后路腰椎间融合术(PE-PLIF)与微创经椎间孔腰椎间融合术(MIS-TLIF)治疗1度腰椎滑脱症的疗效。[方法]回顾性研究2018年7月~2019年9月行手术治疗的56例1度腰椎滑脱症患者,其中25例行PE-PLIF,31例患者行MIS-TLIF。比较两组的围手术期、随访及影像资料。[结果]与MIS-TLIF组相比,PE-PLIF组手术时间延长,但操作切口更小,术中及术后出血更少,术后下地及住院时间更短(P<0.05)。两组并发症发生率无统计学差异(P>0.05)。两组术后腰腿痛 VAS评分、ODI评分均得到明显改善(P<0.05),术后3天PE-PLIF组腰痛VAS评分低于MIS-TLIF组(P<0.05),末次随访组间无明显差异(P>0.05)。术后各时间点两组腿痛VAS评分及ODI评分无明显差异(P>0.05)。两组术后腰椎前凸角(LL)、滑脱角(SA)、滑脱率(SP)及椎间隙高度(DH)均得到明显改善(P<0.05),组间比较无统计学差异(P>0.05)。末次随访时两组融合分级及融合器沉降率无统计学差异(P>0.05)。[结论]与MIS-TLIF相比较,PE-PLIF治疗1度腰椎滑脱症的手术时间延长,但操作切口更小,术中及术后出血更少,术后下地及住院时间更短,且早期腰痛改善更为明显。

    Abstract:

    [Objective] To compare the efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of grade 1 lumbar spondylolisthesis. [Methods] A retrospective study was conducted on 56 patients with grade 1 lumbar spondylolisthesis who underwent surgery from July 2018 to September 2019. Among them, 25 patients underwent PE-PLIF and 31 patients underwent MIS-TLIF. The perioperative, follow-up and imaging data of the two groups were compared. [Results] Compared with the MIS-TLIF group, the PE-PLIF group had significantly longer operation time, smaller working incision, less intraoperative and postoperative blood loss, shorter postoperative ambulation time and hospital stay (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). The VAS score of low back and leg pain, and ODI score of the two groups were significantly improved after operation (P<0.05). The VAS score of low back pain of the PE-PLIF group was lower than that of the MIS-TLIF group at 3 days after operation (P<0.05), while there was no significant difference between the two groups at the latest follow-up (P>0.05). There were no significant differences in VAS score of leg pain and ODI score between the two groups at each time point after operation (P>0.05). The lumbar lordosis (LL), slip angle (SA), slip percentage (SP) and disc height (DH) of the two groups were significantly improved after operation (P<0.05), while there were no significant differences between the two groups (P>0.05). At the latest follow-up, there were no significant differences in fusion grade and cage subsidence rate between the two groups (P>0.05). [Conclusion] Compared with MIS-TLIF, PE-PLIF has longer operation time in the treatment of grade 1 lumbar spondylolisthesis, while it has smaller working incision, less intraoperative and postoperative blood loss, shorter postoperative ambulation time and hospital stay, and more obvious improvement of low back pain at early period after operation.

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  • 收稿日期:2021-01-04
  • 最后修改日期:2021-04-23
  • 录用日期:2021-05-18
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