内镜减压与开放延长PLIF治疗腰椎融合后邻椎病
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1.蚌埠医学院研究生院;2.徐州医科大学研究生院;3.徐州市中心医院;4.上海交通大学医学院附属第九人民医院;5.徐州市中心医院,蚌埠医学院研究生院

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江苏省医学青年人才项目,徐州市引进临床医学专家团队计划,徐州市医学领军人才计划,江苏省卫生健康委员会项目


Endoscopic decompression versus open extension posterior lumbar interbody fusion for adjacent segment diseases after lumbar fusion
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Affiliation:

1.Graduate School of Bengbu Medical University;2.Graduate School of Xuzhou Medical University;3.Xuzhou Central Hospital;4.Ninth People&5.amp;6.#39;7.&8.s Hospital Affiliated to Shanghai Jiao tong University School of Medicine;9.Graduate School of Bengbu Medical University, Xuzhou Central Hospital

Fund Project:

Jiangsu Medical Young Talent Project, Xuzhou introduced clinical medical expert team plan, Xuzhou Leading Medical Talents Program, Project of Jiangsu Provincial Health Commission

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    摘要:

    [目的] 比较后路内镜减压与开放延长后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎融合术后邻椎病的临床疗效。 [方法] 回顾性分析 2017 年 1 月—2020 年 1 月本院收治的邻椎病 26 例患者的临床资料,依据医患沟通结果,12 例采用后路内镜减压(内镜组),14 例采用开放延长PLIF(PLIF组)。比较两组围手术期、随访及影像资料。 [结果] 两组患者均顺利完成手术,术中均无严重并发症。内镜组手术时间、切口总长度、术中失血量、下地时间、住院时间均显著小于PLIF组(P<0.05)。两组患者均获 12 个月以上随访,内镜组完全负重活动时间显著短于 PLIF 组(P<0.05)。随时间推移,两组腰痛VAS、腿痛VAS、ODI和JOA评分均显著改善(P<0.05)。相应时间点,两组患者上述指标的差异均无统计学意义(P>0.05)。影像方面,末次随访时,两组椎管面积、侧隐窝矢径较术前均显著增加(P< 0.05),两组腰椎前凸角无显著变化(P>0.05)。术前两组之间的上述指标比较差异均无统计学意义(P>0.05),末次随访时,内镜组椎管面积、侧隐窝矢径均显著小于PLIF组(P<0.05),两组腰椎前凸角的差异无统计学意义(P>0.05)。 [结论] 后路内镜减压治疗邻椎病具有创伤小、恢复快等优势,可取得与开放延长PLIF同等的治疗效果。

    Abstract:

    [Objective] To compare the clinical efficacy of posterior endoscopic decompression versus open extended posterior lumbar interbody fusion (PLIF) for adjacent segment diseases after lumbar fusion. [Methods] A retrospective study was performed on 26 patients who underwent surgical treatment for adjacent segment diseases after lumbar fusion in our hospital from January 2017 to January 2020. According to the results of doctor-patient communication preoperatively, 12 patients were treated with posterior endoscopic decompression (the endoscopic group), while the remaining 14 patients received PLIF (the PLIF group). The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operations performed successfully without serious complications. The endoscopic group proved significantly superior to the PLIF group in terms of operation time, incision length, intraoperative blood loss and hospital stay (P<0.05) . All patients in both groups were followed up for more than 12 months, and the endoscopic group resumed full weight-bearing activity significantly earlier than the PLIF group (P<0.05) . The low back pain VAS, leg pain VAS, ODI and JOA scores improved significantly over time in both groups (P<0.05) . At any corresponding time points, there was no significant difference in the above items between the two groups (P>0.05) . Radiographically, at the last follow-up, the spinal canal area and sagittal diameter of lateral recess significantly increased in both groups compared with those preoperatively (P<0.05) , while the lumbar lordosis angle remained unchanged (P>0.05) . Although there was no significant difference in the above indexes between the two groups before operation (P>0.05) , at the last follow-up , the endoscopic group proved significantly inferior to the PLIF group in the spinal canal area and sagittal diameter of lateral recess (P<0.05) , while there was no significant difference in lumbar lordosis angle between the two groups (P>0.05) . [Conclusion] The posterior endoscopic decompression has the advantages of quite less trauma and faster postoperative recovery for treating adjacent segment disease, and it achieves the similar clinical outcome as open extended PLIF.

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  • 收稿日期:2022-11-07
  • 最后修改日期:2023-03-14
  • 录用日期:2023-03-30
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