Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病的临床疗效

【摘要】 目的：探讨Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病的效果。方法：回顾性分析2021年9月~2022年9月我院收治的80例退变性腰椎疾病患者的病历资料，根据患者治疗方式分为观察组（38例，男17例，女21例，年龄61.0±4.9岁）和对照组（42例，男20例，女22例，年龄60.5±5.4岁），观察组患者采取Delta大通道内镜下Endo-PLIF治疗，对照组采取开放后路腰椎椎间融合术治疗，记录两组患者术中出血量、术后引流量、手术时间、手术切口长度、住院时间，比较患者并发症发生情况。于术前、术后1周、1个月、3个月、6个月使用视觉模拟量表（visual analogue scale，VAS）评分评估患者腰痛情况，并采用Oswestry功能障碍指数（Oswestry disability index，ODI）评估患者腰椎功能；使用改良Macnab标准对患者进行疗效评估。根据患者术后1年随访时的腰椎影像学复查结果，使用Bridwell椎间融合标准对患者手术节段融合情况进行评估。结果：观察组患者的术中出血量及术后引流量分别低于对照组（88.46±10.98mL vs 112.99±12.01mL、159.73±18.42mL vs 201.36±23.06mL，P<0.05），手术切口及住院时间分别短于对照组（1.54±0.36cm vs 5.43±1.01cm、6.79±1.22d vs 8.03±1.43d，P<0.05），手术时间长于对照组（162.33±19.57min vs 126.87±23.15min，P<0.05）。80例患者术后均获随访，随访时间15~40个月（19.0±6.3个月）。观察组患者术后1周、术后1个月的VAS评分分别为2.46±0.51分、1.21±0.38分，ODI分别为（17.84±4.15）%、（10.69±1.88）%，均低于对照组[VAS评分分别为3.68±0.62分、2.01±0.41分，ODI分别为（21.33±3.48）%、（12.33±2.17）%，均P<0.05]，两组患者术后3个月、术后6个月的VAS评分比较无统计学差异（P>0.05）。观察组治疗优良率为92.11%，与对照组的85.71%比较无统计学意义（P=0.487）。两组患者融合分级比较，差异无统计学意义（Z=0.487，P=0.624）。观察组术后并发症发生率为5.26%，与对照组的9.52%比较无统计学差异（P=0.678）。结论：Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病效果良好，可以减少术中出血量，缩短手术切口和住院时间，更快改善患者术后短期内疼痛、腰椎功能，安全性较好。

Clinical effect of posterior lumbar interbody fusion under Delta large channel endoscope on degenerative lumbar diseases

【Abstract】 Objectives: To explore the curative effect of posterior lumbar interbody fusion under Delta large channel endoscope(Endo-PLIF) on degenerative lumbar diseases. Methods: A retrospective analysis was performed on the case data of 80 patients with degenerative lumbar diseases treated in the hospital between September 2021 and September 2022. The patients were divided into observation group(38 cases, 17 males and 21 females, aged 61.0±4.9 years) and control group(42 cases, 20 males and 22 females, aged 60.5±5.4 years). The patients in the observation group were treated with Endo-PLIF, while those in the control group were treated with open posterior lumbar interbody fusion. The intraoperative blood loss, postoperative drainage volume, operative time, length of surgical incisions, length of hospital stays, and complications of both groups of patients were recorded and compared. The visual analogue scale(VAS) was used to evaluate patients′ low back pain and Oswestry disability index(ODI) was used to assess the lumbar function before surgery, at 1 week, 1 month, 3 months and 6 months after surgery. The patients were also evaluated using the modified Macnab criteria for treatment efficacy, and using the Bridwell criteria for assessing the segmental fusion within 1 year after surgery. Results: The intraoperative blood loss and postoperative drainage volume in the observation group were 88.46±10.98mL and 159.73±18.42mL, lower than those in the control group 112.99±12.01mL and 201.36±23.06mL(P<0.05); The lengths of surgical incision and hospital stays were 1.54±0.36cm and 6.79±1.22d, which were shorter in the observation group than those in the control group of 5.43±1.01cm and 8.03±1.43d(P<0.05); And the operative time was longer in the observation group than that in the control group(162.33±19.57min vs 126.87±23.15min, P<0.05). All the patients were followed up for 15-40 months(19.0±6.3 months). At 1 week and 1 month after surgery, VAS scores in observation group were 2.46±0.51 and 1.21±0.38, and ODI were (17.84±4.15)% and (10.69±1.88)%, which were lower than those in the control group[VAS score: 3.68±0.62, 2.01±0.41; ODI: (21.33±3.48)%, (12.33±2.17)%, P<0.05]. At 3 months and 6 months after surgery, there was no significant difference in VAS scores between the two groups(P>0.05). There was neither significant difference in the excellent and good rate of treatment (92.11% vs 85.71%, P=0.487) nor significant difference in fusion grading between the observation group and control group(Z=0.487, P=0.624). No significant difference was noticed in the incidence of postoperative complications between observation group and control group(5.26% vs 9.52%, P=0.678). Conclusions: The curative effect of Endo-PLIF is satisfactory on degenerative lumbar diseases, which can reduce intraoperative blood loss, shorten surgical incision and hospitalization time, improve short-term pain and lumbar function faster, with good safety.