两种内镜腰椎融合技术治疗退行性疾病的手术侵入性、隐性失血和结果:一项比较研究。

IF 2.1 4区 医学 Q3 CLINICAL NEUROLOGY
Muhadasi Tuerxunyiming , Xingang Wang , Shihao Zhou , Xiaowan Xu , Jianpeng Zheng , Mengru Guan , Qiuyun Lin , Yamin Li
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引用次数: 0

摘要

背景:脊柱内窥镜技术的快速发展强调了对各种手术入路进行比较评估的必要性。本研究比较了单侧双门静脉内窥镜腰椎椎间融合术(ULIF)和全内窥镜经椎间孔腰椎椎间融合术(Endo-PLIF)治疗腰椎退行性疾病(LDD)的效果,重点研究了手术侵入性、隐性失血量(HBL)和临床结果。方法:在2021年1月至2024年1月期间,共有120名诊断为LDD的患者入组。其中,63例患者接受了ULIF, 57例接受了Endo-PLIF。记录围手术期指标,包括手术时间、住院时间、切口长度、术中出血量、椎间盘和椎间孔高度变化。临床结果通过视觉模拟量表(VAS)评估背部和腿部疼痛,Oswestry残疾指数(ODI),以及最后随访时修改的Macnab标准。术前、术后3天、3个月、6个月、12个月进行评估。融合率和并发症发生率也被记录下来。术前、术后第1、3、5天通过测定血清肌酸激酶(CK)和c反应蛋白(CRP)水平来量化肌肉损伤。采用描述性统计和多重比较检验评价两手术组临床指标的差异。VAS评分为主要临床结果。使用广义线性混合模型分析纵向数据,以评估组间随时间的差异。结果:基线人口统计学和手术数据在两组之间具有可比性。Endo-PLIF组的CRP和CK水平普遍低于ULIF组,尤其是术后第3天的CRP和术后第1天的CK水平。与ULIF组相比,Endo-PLIF组的总失血量、术后失血量和隐性失血量均显著减少。两组术后住院时间差异无统计学意义。两组VAS疼痛评分和ODI均有改善。术后第三天观察到VAS背部疼痛明显减轻,而术后3天和3个月腿部疼痛明显改善。在最后的随访中,两组之间的临床结果没有进一步的差异。结论:两种手术方式均能显著缓解腰痛,改善功能。尽管ULIF在术后早期疼痛控制和功能恢复方面显示出明显的优势,但在长期随访中,两种技术的结果具有可比性。然而,Endo-PLIF在减少手术创伤和失血方面表现出显著的优势。总的来说,这两种方法都是可行的治疗选择,具有可接受的安全性。方法的选择应根据患者的具体情况,考虑到早期恢复和手术侵入性之间的权衡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical Invasiveness, Hidden Blood Loss, and Outcomes of 2 Endoscopic Lumbar Fusion Techniques for Degenerative Disease: A Comparative Study

Background

The rapid advancement of spinal endoscopic techniques has underscored the need for comparative evaluations of various surgical approaches. This study compares unilateral biportal endoscopic lumbar interbody fusion (ULIF) and full-endoscopic posterior lumbar interbody fusion (Endo-PLIF) in the treatment of lumbar degenerative diseases, with a focus on surgical invasiveness, hidden blood loss, and clinical outcomes.

Methods

A total of 120 patients diagnosed with lumbar degenerative diseases were enrolled between January 2021 and January 2024. Of these, 63 patients underwent ULIF and 57 received Endo-PLIF. Perioperative indicators were recorded, including operative time, hospital stay, incision length, intraoperative blood loss, and changes in intervertebral disc and foraminal height. Clinical outcomes were assessed using visual analog scale (VAS) scores for back and leg pain, the Oswestry Disability Index, and the modified Macnab criteria at the final follow-up. Assessments were conducted preoperatively and at 3 days, 3 months, 6 months, and 12 months postoperatively. Fusion rates and complication incidences were also documented. Muscle injury was quantified by measuring serum levels of creatine kinase (CK) and C-reactive protein (CRP) preoperatively and on postoperative days 1, 3, and 5. Descriptive statistics and multiple comparison tests were applied to assess differences in clinical indicators between the 2 surgical groups. The VAS score served as the primary clinical outcome. Longitudinal data were analyzed using a generalized linear mixed model to evaluate intergroup differences over time.

Results

Baseline demographic and surgical data were comparable between the 2 groups. The CRP and CK levels in the Endo-PLIF group were generally lower than those in the ULIF group, particularly on postoperative day 3 for CRP and on postoperative day 1 for CK. Compared to the ULIF group, the Endo-PLIF group exhibited significantly reduced total blood loss, postoperative blood loss, and hidden blood loss. No significant difference was observed in postoperative hospital stay duration between the groups. Both groups showed improvements in VAS pain scores and Oswestry Disability Index. A significant reduction in VAS back pain was observed on the third day after ULIF, while leg pain improved significantly at 3 days and 3 months postsurgery. At the final follow-up, no further differences in clinical outcomes were observed between the 2 groups.

Conclusions

Both surgical methods resulted in significant relief of back pain and functional improvement. Although ULIF showed a distinct advantage in early postoperative pain control and functional recovery, outcomes for both techniques became comparable during long-term follow-up. However, Endo-PLIF exhibited a significant advantage in terms of reduced surgical trauma and blood loss. Overall, both methods represent viable treatment options with acceptable safety profiles. The choice of approach should be tailored to the individual patient’s condition, considering the trade-offs between early recovery and surgical invasiveness.
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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