Objective:

To compare the mid-term effectiveness of unilateral biportal endoscopy (UBE)-transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) assisted with three-dimensional microscope in the treatment of single-level lumbar spondylolisthesis.

Methods:

A total of 41 single level lumbar spondylolisthesis patients who met the selection criteria were retrospectively collected between June 2018 and September 2019. Twenty-three patients were treated with UBE-TLIF (study group) and 18 with MIS-TLIF assisted with three-dimensional microscope (control group). There was no significant difference in gender, age, Meyerding degree of slippage, type of spondylolisthesis, lesion segment, course of disease, and preoperative hemoglobin (Hb) level, visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar lordosis (LL), and disc height (DH) between the two groups (P>0.05). The operation time, hospitalization time, intraoperative blood loss, Hb level between preoperative and postoperative at 1 day, and complications were compared between the two groups. The recovery of clinical sign and symptom was evaluated by VAS score and ODI before operation, and at 1 month, 3 months, 1 year, and 3 years after operation. The LL and DH were measured by radiography before operation and at last follow-up, and the fusion rate was calculated according to Suk grade at last follow-up.

Results:

All the operations were successfully completed. There was no significant difference in operation time between the two groups (P>0.05); the hospitalization time, intraoperative blood loss, and Hb difference between pre- and post-operation in the study group were significantly less than those in the control group (P<0.05). Both groups were followed up 36-48 months, with an average of 39.2 months. In the study group, 1 case of dural tear and 2 cases of Cage subsidence occurred, without postoperative infection and epidural hematoma; in the control group, infection occurred in 1 case, dural tear in 2 cases, Cage subsidence in 1 case, and no epidural hematoma occurred; there was no significant difference in the incidence of complications between the two groups (13.04% vs. 22.22%) (χ²=0.601, P=0.438). The VAS score and ODI at each time point after operation in both groups significantly improved when compared with those before operation, and further improved with time (P<0.05). There was no significant difference in VAS scores between the two groups at each time point after operation (P>0.05); the ODI of the study group was significantly lower than that of the control group at 1 and 3 months after operation (P<0.05), and there was no significant difference between the two groups at other time points (P>0.05). The imaging test showed that the intervertebral fusion rates were 95.7% in the study group and 94.4% in the control group at last follow-up, with no significant difference (χ²=0.032, P=0.859). At last follow-up, LL and DH in the two groups significantly improved when compared with those before operation (P<0.05), and the difference between before and after operation showed no significant difference between the two groups (P>0.05).

Conclusion:

Both UBE-TLIF and MIS-TLIF assisted with three-dimensional microscope have the advantages of clear intraoperative field and high surgical efficiency in treating lumbar spondylolisthesis, and can obtain satisfactory mid-term effectiveness. Compared with MIS-TLIF assisted with three-dimensional microscope, UBE-TLIF has the advantages of less bleeding and faster recovery.

目的:

比较单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）下经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion，TLIF）与3D显微镜辅助下微创经椎间孔腰椎椎体间融合术（minimally invasive surgery transforaminal lumbar interbody fusion，MIS-TLIF）治疗单节段腰椎滑脱症的中期疗效。.

方法:

回顾分析2018年6月—2019年9月收治且符合选择标准的41例单节段腰椎滑脱症患者临床资料，其中23例采用UBE-TLIF治疗（研究组），18例采用3D显微镜辅助下MIS-TLIF治疗（对照组）。两组患者性别、年龄、滑脱程度Meyerding分级、滑脱类别、病变节段、病程和术前血红蛋白（hemoglobin，Hb）水平、疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、腰椎前凸角（lumbar lordosis，LL）和椎间隙高度 （disc height，DH）等资料比较差异均无统计学意义（P>0.05）。记录并比较两组患者手术时间、术中出血量、住院时间、术前和术后1 d Hb水平，以及术后并发症发生情况；根据术前，术后1、3个月及术后1、3年VAS评分和ODI评估患者临床症状恢复情况；影像学测量术前及末次随访时LL和DH，并根据Suk分级计算末次随访时总体融合率。.

结果:

两组患者均顺利完成手术。两组手术时间比较差异无统计学意义（P>0.05）；研究组住院时间、术中出血量和手术前后Hb水平差值明显少于对照组（P<0.05）。两组患者均获随访，随访时间36～48个月，平均39.2个月。研究组出现硬膜撕裂1例、椎间融合器下沉2例，无术后感染及硬膜外血肿发生；对照组出现感染1例、硬膜撕裂2例、椎间融合器下沉1例，无硬膜外血肿发生；两组并发症发生率（13.04% vs. 22.22%）比较差异无统计学意义（χ²=0.601，P=0.438）。两组术后各时间点VAS评分和ODI均较术前明显改善，并随时间延长进一步改善（P<0.05）。术后各时间点两组间VAS评分比较差异无统计学意义（P>0.05）；术后1、3个月研究组ODI明显低于对照组（P<0.05），其余时间点两组间差异无统计学意义（P>0.05）。影像学检测示，末次随访时研究组椎间总体融合率为95.7%，对照组为94.4%，差异无统计学意义（χ²=0.032，P=0.859）。末次随访时，两组LL和DH均较术前显著改善（P<0.05），两组手术前后差值比较差异无统计学意义（P>0.05）。.

结论:

UBE-TLIF和3D显微镜辅助下MIS-TLIF治疗腰椎滑脱症均安全有效，具有术中视野清晰、手术效率高的优势，可获得满意中期疗效；与 3D 显微镜辅助下 MIS-TLIF 相比，UBE-TLIF具有出血少、术后早期恢复更快的优势。.