摘要
Abstract
Objective To compare the clinical efficacy between percutaneous coaxial large-channel endoscopic lumbar interbody fusion(PE-LIF)and Wiltse-approach transforaminal lumbar interbody fusion(MIS-TILF)in the treatment of degenerative lumbar spinal stenosis.Methods A retrospective analysis was performed on the clinical data of 65 patients who underwent lumbar decompression and interbody fusion surgery in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2021 to December 2021 for degenerative lumbar spinal stenosis,according to different surgical methods,it was divided into PE-LIF group(24 cases)and MIS-TLIF group(41 cases).The operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital days and complications of the two groups were compared.The levels of whole blood C-reactive protein(CRP)and serum phosphocreatine kinase(CK)before surgery,and at 1 d and 7 d after surgery were compared between the two groups to evaluate the degree of paravertebral muscle damage.The visual analogue score(VAS)of low back and lower extremity pain before surgery,and at 3 d,1 month,3 months and 12 months after surgery,and the Oswestry disability index(ODI)at preoperative,and at 3 months and 12 months of postoperation were recorded and compared between the two groups to assess the surgical efficacy,and the improved MacNab criteria were used to evaluate the excellent and good rates of the two groups at the last follow-up.The Brantigan criteria was used to evaluate the interbody fusion in the two groups.Results Patients in both groups were followed up for 12 to 22 months,with an average of 17.1 months.The intraoperative blood loss,postoperative drainage volume and postoperative hospital stays of PE-LIF group were less than the MIS-TLIF group(P<0.05),but the PE-LIF group had a longer operation time(P<0.05).There was no significant difference in the content of CRP before surgery and at 1day after surgery between the two groups(P>0.05),but the content of CRP in the PE-LIF group was lower than that in the MIS-TILF group at 3 d of postoperation(P<0.05).There was no significant difference in serum CK between the two groups before surgery(P>0.05),but the serum CK of the PE-LIF group at 1 d and 7 d after surgery was lower than that in the MIS-TILF group(P<0.05).The VAS score of low back and lower extremity pain and the ODI score at each time point after surgery in the two groups decreased significantly compared with the preoperative period(P<0.05),but there was no significant difference between two groups(P>0.05).At 12 months after surgery,the interbody fusion of the surgical segment between two groups were all reached to 3 level or above,and there was no significant difference in the interbody fusion rate between the two groups(90.2%VS 87.5%,P>0.05).There was no significant difference in postoperative complications and the efficacy evaluation of MacNab criteria between the two groups(P>0.05).Conclusion The surgery of PE-LIF and MIS-TLIF can both effectively relieve pain,improve lumbar spine function,and have a satisfied intervertebral fusion rate in the treatment of degenerative lumbar spinal stenosis.Moreover,PE-LIF has less intraoperative blood loss and postoperative drainage,and less damage to paravertebral muscles,which is more in line with the concept of minimally invasive spine surgery.关键词
经皮大通道脊柱内镜/Wilste入路/椎间融合/退变性腰椎椎管狭窄症Key words
Percutaneous coaxial large-channel spinal endoscopy/Wilste approach/Intervertebral fusion/Degenerative lumbar spinal stenosis分类
医药卫生
