广西医学

目的探讨大通道下内镜下经皮腰椎后路椎间融合术（Endo⁃PLIF）治疗Ⅰ~Ⅱ度腰椎滑脱症患者的有效性和安全性。方法回顾性分析46例行大通道下Endo⁃PLIF治疗的腰椎滑脱症患者的手术资料，记录手术时间、术中出血量、术后住院时间、抗生素使用时间及手术相关并发症的发生情况，比较手术前后的疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）、手术节段椎间隙高度和腰椎前凸角。结果 46例患者均顺利完成手术，术后随访12.0~19.0（14.2±3.2）个月。患者的手术时间为231.72（170.50，290.00）min，术中出血量为80.00（50.00，100.00）mL，术后住院时间为3.00~11.00（5.26±2.16）d，抗生素使用时间为1.00~7.00（2.98±1.42）d。术后1周、术后1年，患者腰部、下肢疼痛VAS评分及ODI较术前降低；术后1周、术后1年，手术节段椎间隙高度较术前增加，术后1年，腰椎前凸角较术前增加（P<0.05）。所有患者术中及术后均未输血，均未发生感染、融合失败、硬脊膜撕裂等并发症，1例患者术后出现一侧内固定松动、1例患者术后出现引流不畅，予以对症处理后症状明显缓解。结论大通道下Endo⁃PLIF治疗Ⅰ~Ⅱ度腰椎滑脱症患者的临床疗效满意，具有创伤小、康复快等优点。

Objective To explore the effectiveness and safeness of endoscopic posterior lumbar interbody fusion (Endo⁃PLIF) via large channel for the treatment of patients with lumbar spondylolisthesis in degree Ⅰ-Ⅱ. Methods The surgical data of 46 patients with lumbar spondylolisthesis undergoing Endo⁃PLIF via large channel were retrospectively analyzed. The operation duration, intraoperative bleeding volume, postoperative length of hospital stay, duration of antibiotic use, the occurrence status of operative⁃associated complications were recorded. The pre⁃ and postoperative Visual Analogue Scale (VAS) score, Oswestry disability index (ODI), and lumbar intervertebral space height and lumbar lordosis angle of operative segments were compared. Results All 46 patients successfully completed the operation. Patients were followed up for 12.0 to 19.0 (14.2±3.2) months. The operation duration of patients was 231.72 (170.50, 290.00) minutes, intraoperative bleeding volume was 80.00 (50.00, 100.00) mL, postoperative length of hospital stay was 3.00 to 11.00 (5.26±2.16) days, and duration of antibiotic use was 1.00 to 7.00 (2.98±1.42) days. One week and 1 year after operation, the VAS scores and ODI for low back and lower limbs were decreased as compared with before operation. One week and 1 year after operation, lumbar intervertebral space height was increased as compared with before operation; furthermore, lumbar lordosis angle of operative segments was enlarged as compared with before operation one year after operation (P<0.05). No intraoperative or postoperative blood transfusion, infection, fusion failure, dural tear and other complications occurred in all patients. One patient had unilateral internal fixation loosening after operation, and 1 patient was found to have inadequate drainage after operation, and the symptoms were significantly relieved after symptomatic treatment. Conclusion The clinical efficacy of Endo⁃PLIF via large channel for the treatment of patients with lumbar spondylolisthesis in degree Ⅰ-Ⅱ is satisfactory, with the advantages of less trauma and fast recovery, etc.