局麻侧卧位内镜下腰椎融合术治疗腰椎滑脱症的临床研究

目的 分析局麻侧卧位内镜下腰椎融合术(postemlateral endoscopic lumbar interbody fusion，PE-LIF)治疗腰椎滑脱症的安全性和临床疗效。方法 回顾性分析2020年1月至2022年1月我科行PE-LIF治疗的58例腰椎滑脱症患者。统计手术时间、术中出血量、住院时间及并发症等临床指标，采用Oswestry功能障碍指数（ODI）评估腰椎功能，疼痛视觉模拟评分(visual analog scale，VAS)评价临床疗效。术前、术后1月、术后6月和术后1年随访时拍摄腰椎X线片并测量手术节段椎间隙高度、腰椎前凸角、手术节段前凸角，术后1月用腰椎CT评估椎弓根螺钉置钉准确率，术后6月、术后12个月通过CT评估融合率，并进行统计学分析。结果 手术时间为 130~190min，平均为（160±30）min；术中出血量为52~120 ml，平均为（63±15）ml。住院时间为6~15 d，平均为（9.3±3.5）d。所有患者均获得随访，随访时间为13~ 26个月，平均（17.4±2.8）个月。术前患者腰痛VAS为7.28±0．93分，术后1年为2.22±0.57分：术前下肢痛VAS为7.82±1.40分，术后1年为2.38±0.63分：术前ODI为(65.80±9．88)％，术后1年为(12.54±4.53），术后腰痛、下肢痛较术前差异均有统计学意义（P＜0.05）。椎间隙高度术前为（8.3±1.5）mm；术后1年为（10.8±1.6）mm；术后较术前差异均有统计学意义（P＜0.05）。腰椎前凸角术前为（31.7°±7.3°）；术后1年为（37.9°±4.4°）；术后较术前差异均有统计学意义（P＜0.05）。手术节段前凸角术前为（13.1°±8.1°）；术后1年为（16.1°±2.4°）；术后较术前差异均有统计学意义（P＜0.05）。术后1年时，所有病例均获得骨性融合，未发生神经根损伤、脊柱感染、椎管内血肿、融合器移位、断钉断棒等其他严重并发症。结论 局麻侧卧位内镜下腰椎融合术治疗腰椎滑脱症安全可靠，临床疗效满意。

Clinical study on the treatment of lumbar spondylolisthesis by postemlateral endoscopic lumbar fusion in lateral lying position under local anesthesia

Objective: To analyze the safety and clinical effect of lateral endoscopic lumbar interbody fusion (PE-LIF) in the treatment of lumbar spondylolisthesis. Methods: From January 2020 to January 2022, 58 patients with lumbar spondylolisthesis treated with PE-LIF in our department were retrospectively analyzed. The operation time, intraoperative bleeding, hospital stay and complications were counted, and the lumbar function was evaluated by Oswestry dysfunction index (ODI), and the clinical efficacy was evaluated by visual analog scale (VAS). At the follow-up before operation, 1 month after operation, 6 months and 1 year after operation, the lumbar X-ray film was taken and the height of intervertebral space, lumbar lordosis angle, and anterior lordosis angle of the surgical segment were measured. At the first month after operation, the accuracy of pedicle screw placement was evaluated by lumbar CT. At the sixth month and 12 months after operation, the fusion rate was evaluated by CT and statistically analyzed. Results: The operation time was 130~190 min, with an average of (160 ± 30) min; The intraoperative bleeding volume was 52~120 ml, with an average of (63 ± 15) ml. The hospital stay was 6-15 days, with an average of (9.3 ± 3.5) days. All patients were followed up for 13 to 26 months, with an average of (17.4 ± 2.8) months. The VAS of patients with low back pain was 7.28 ± 0.93 points before operation, 2.22 ± 0.57 points after 1 year of operation, The VAS of patients with lower limb pain was 7.82 ± 1.40 points before operation, 2.38 ± 0.63 points after 1 year of operation, (65.80 ± 9.88)% before operation, and (12.54 ± 4.53) after 1 year of operation. There were statistically significant differences in low back pain and lower limb pain after operation compared with that before operation (P<0.05). The height of intervertebral space was (8.3 ± 1.5) mm before operation; One year after the operation, it was (10.8 ± 1.6) mm; There were statistically significant differences between postoperative and preoperative (P<0.05). The lumbar lordosis angle was (31.7 ° ± 7.3 °) before operation; One year after operation was (37.9 ° ± 4.4 °); There were statistically significant differences between postoperative and preoperative (P<0.05). The anterior convex angle of the surgical segment was (13.1 ° ± 8.1 °) before operation; One year after operation was (16.1 ° ± 2.4 °); There were statistically significant differences between postoperative and preoperative (P<0.05). At 1 year after the operation, all cases obtained bony fusion without other serious complications such as nerve root injury, spinal infection, intraspinal hematoma, fusion cage displacement, broken nails and rods. Conclusion: Endoscopic lumbar fusion in lateral recumbent position under local anesthesia is safe and reliable in the treatment of lumbar spondylolisthesis, and the clinical effect is satisfactory.