Endo-TLIF和TLIF双节段腰椎椎间融合术的近期疗效比较

Comparison of the Short-Term Curative Effects of Endo-TLIF and TLIF in the Treatment of Double-Level Lumbar Interbody Fusion

摘要: 目的：对比研究数字导航协助的脊柱内镜下经腰椎侧入路椎体间融合术(Endo-TLIF)和常规开放腰椎侧入路椎间融合术(TLIF)治疗双节段退变性腰椎疾病的疗效差异。方法：回顾性分析2022年3月至2022年9月33例因双节段退变性腰椎病变行腰椎椎间融合术治疗患者的临床资料，其中16例行Endo-TLIF (Endo-TLIF组)、17例行TLIF (TLIF组)。比较两组的手术所用时间、术中X线射线透视次数、术中出血量、术后切口渗血引流量、术后下床时间，手术前、后腰腿疼痛视觉模拟量表(VAS)及Oswestry功能障碍指数(ODI)评分。结果：Endo-TLIF组手术时间为255 ± 30 min、射线暴露次数为15.06 ± 2.72次，均明显多于TLIF组的175.88 ± 36.41 min和4.59 ± 3.79次(t = 6.788，t = 13.71，均P < 0.01)；术中失血量为86.25 ± 53.15 ml、术后引流量为0 ml，术后2天VAS和ODI评分分别为(1.69 ± 0.60)和(26.13 ± 9.78)分，均明显优于TLIF组的283.35 ± 113 ml、371.18 ± 115.4 ml，(2.18 ± 0.64)和(33.88 ± 9.58)分(t = 6.343, t = 10.373, t = 2.265, t = 2.301, P < 0.01)。结论：数字导航协助的Endo-TLIF技术在治疗双节段退变性腰椎病变疗效肯定。与传统开放TLIF相比，Endo-TLIF手术创伤低、出血量减少、康复快，但其技术难度增大，术中X线透视次数增多，手术耗时延长。

Abstract: Objective: To explore the short-term effects of robot-assisted endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) assisted by digital navigation and transforaminal lumbar interbody fusion (TLIF) in the treatment of double-level lumbar interbody fusion. Methods: A retrospective analysis the Department of Spinal Surgery, from March 2022 to September 2022, 33 patients with Lumbar interbody fusion who underwent lumbar decompression and fusion surgery were included in this study, of which 16 patients underwent robot-assisted Endo-TLIF surgery (Endo-TLIF group) and 17 patients received TLIF surgery (TLIF group). The operation time, the number of intraoperative X-rays, the amount of intraoperative blood loss, the amount of postoperative incision blood leakage, the postoperative time to get out of bed, the visual analogue scale (VAS) and the Oswestry dysfunction index (ODI) scores of pain before and after surgery were compared between the two groups. Results: The operation time and radiation exposure were 255 ± 30 min and the number of radiation exposures were 15.06 ± 2.72 times in the Endo-TLIF group, which were significantly higher than those (175.88 ± 36.41 min and 4.59 ± 3.79 times) in the TLIF group (t = 6.788, t = 13.71, P < 0.01); the intraoperative blood loss was 86.25 ± 53.15 ml, the postoperative drainage volume was 0 ml, and the VAS and ODI scores were (1.69 ± 0.60) and (26.13 ± 9.78) on the 2nd day after operation, respectively, which were significantly better than those of the TLIF group (283.35 ± 113ml, 371.18 ± 115.4 ml), (2.18 ± 0.64) and (33.88 ± 9.58) points (t = 6.343, t = 10.373, t = 2.265, t = 2.301, P < 0.01). Conclusion: The Endo-TLIF surgery assisted by digital navigation is effective in the treatment of double-level lumbar spinal stenosis with lumbar instability compared with traditional TLIF surgery, navigation-assisted Endo-TLIF surgery can significantly reduce the intraoperative blood loss, shorten the hospital stay, and accelerate the patients’ recovery. But it is more difficult to operate, more times of fluoroscopy and longer operation time.