比较UBE-TLIF与TLIF治疗连续性双节段腰椎管狭窄伴腰椎不稳的临床疗效

Comparing the Clinical Efficacy of UBE-TLIF and TLIF for Contiguous Dual-Level Lumbar Spinal Stenosis with Lumbar Instability

摘要: 目的：比较单侧双通道内镜下经椎间孔腰椎椎体间融合术(UBE-TLIF)与传统经椎间孔腰椎椎体间融合术(TLIF)治疗连续性双节段腰椎管狭窄伴腰椎不稳的临床疗效。方法：回顾性分析2021年1月至2022年12月收治的45例连续性双节段腰椎管狭窄伴腰椎不稳定患者，其中UBE-TLIF组17例，TLIF组28例。比较两组患者的手术时间、术中出血量、术后引流量、住院时间、并发症、VAS (疼痛视觉模拟量表评分)、JOA (日本骨科协会评分)、ODI (Oswestry功能障碍指数)、椎间盘高度及融合率。结果：与TLIF组相比，UBE-TLIF组术中出血量更少、术后引流量更少、引流时间及住院时间更短(P < 0.05)，但手术时间更长(P < 0.05)。两组术后1周腰痛VAS评分、JOA评分及ODI评分差异有统计学意义(P < 0.05)，但术后远期功能恢复、融合率及并发症发生率差异无统计学意义(P > 0.05)。结论：UBE-TLIF是治疗连续双节段腰椎管狭窄伴腰椎不稳的一种有效且微创的替代方法。它具备减少手术创伤、降低术中失血量、加快术后恢复等优势，同时实现相当的融合率和功能预后。

Abstract: Objective: This paper aims to compare the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus conventional transforaminal lumbar interbody fusion (TLIF) in the treatment of contiguous dual-level lumbar spinal stenosis with lumbar instability. Methods: A retrospective analysis was conducted on 45 patients with contiguous dual-level lumbar spinal stenosis with lumbar instability who underwent lumbar fusion surgery between January 2021 and December 2022. 17 patients were treated with UBE-TLIF, and 28 patients received conventional TLIF. Operative time, intraoperative blood loss, postoperative drainage volume, drainage duration, hospital stay, complications, Visual Analog Scale (VAS) scores for back and leg pain, Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI), disc height, and fusion rate were compared between the two groups. Results: Compared with the TLIF group, the UBE-TLIF group had significantly less intraoperative blood loss, lower postoperative drainage volume, shorter drainage duration, and shorter postoperative hospital stay (all P < 0.05). However, the UBE-TLIF group had a significantly longer operative time (P < 0.05). At one week postoperatively, the UBE-TLIF group showed significantly better VAS scores for low back pain, JOA scores, and ODI scores compared to the TLIF group (P < 0.05). No significant differences were observed between the two groups in leg pain VAS scores, long-term functional outcomes, fusion rate, or complication rate (P > 0.05). Conclusion: UBE-TLIF is an effective and minimally invasive alternative to conventional TLIF for contiguous dual-level lumbar spinal stenosis with lumbar instability. It offers advantages including reduced surgical trauma, less blood loss, and faster postoperative recovery, while achieving comparable fusion rates and functional outcomes.