目的:我们旨在评估超声骨刮匙(UBC)辅助的双侧减压微创经椎间孔腰椎椎间融合术(MIS-TLIF)治疗重度退行性腰椎管狭窄症(DLSS)和传统工具椎板切除减压MIS-TLIF治疗重度DLSS的临床疗效。
方法:回顾性分析2017年1月至2021年12月收治的128例单节段重度DLSS患者的临床资料。其中,67例患者采用超声骨刮匙进行单侧开窗和双侧减压MIS-TLIF(UBC组),而61例患者使用传统工具进行单侧开窗和双侧减压MIS-TLIF治疗(传统组,控制)。术前采用视觉模拟量表(VAS)评估背部及下肢疼痛,术后即刻,一个星期,术后3、6、12、24个月。采用Oswestry残疾指数(ODI)和苏黎世跛行评分(ZCQ)评估下背部和下肢功能的改善。在最后一次随访中,使用Bridwell植骨融合标准来评估植骨融合。
结果:UBC组椎板切除术的减压时间明显短于传统组(对照组),术中出血量和术后引流量明显少于对照组(P<0.05)。VAS,ODI,两组患者术后ZCQ评分均较术前明显改善(P<0.05)。UBC组术后即刻及术后1周VAS评分均优于对照组(P<0.05)。UBC组术后即刻下肢VAS评分优于对照组(P<0.05)。围手术期并发症的发生率,住院时间,硬脑膜囊横截面积(CSA),硬膜囊CSA改善率两组间差异无统计学意义(P>0.05)。两组患者术前VAS和ODI评分差异无统计学意义。三,六个月,一年,术后2年(P>0.05)。两组术前1周ZCQ评分无明显差异,六个月,一年,术后2年(P>0.05)。根据Bridwell植骨融合标准,末次随访时,两组间植骨融合无统计学意义(P>0.05)。
结论:UBC单侧开窗双侧减压MIS-TLIF治疗重症DLSS可达到传统工具单侧开窗双侧减压MIS-TLIF的临床疗效,减少术中出血量和术后引流量。它还可以缩短操作时间,有效降低操作人员的工作强度,并在短期随访中减轻下腰痛的程度。因此,这是一种安全有效的手术方法。
OBJECTIVE: We aimed to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by an ultrasonic bone curette (UBC) for treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MIS-TLIF for treating severe DLSS.
METHODS: The clinical data of 128 patients with single-segment severe DLSS who were admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using an ultrasonic bone curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate back and lower limb pain before the operation,immediate postoperative, and one week, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were employed to evaluate the improvement in low back and lower limb function. At the last follow-up, the Bridwell bone graft fusion standard was utilized to evaluate bone graft fusion.
RESULTS: The decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less in those in the control group (P < 0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P < 0.05). The UBC group had better VAS back scores than the control group immediate postoperative and one week after the operation(P < 0.05). The UBC group had better VAS lower limb scores than the control group immediate postoperative (P < 0.05).The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P > 0.05). VAS and ODI scores did not differ significantly between the two groups before,three, six months, one year, and two years after surgery (P > 0.05). The ZCQ scores did not differ significantly between the two groups before the operation at one week, six months, one year, and two years after the operation (P > 0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P > 0.05) at the last follow-up.
CONCLUSIONS: UBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can achieve clinical efficacy as traditional tool unilateral fenestration bilateral decompression MIS-TLIF and reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-ups. Therefore, this is a safe and effective surgical method.