广西医学

目的比较关节镜辅助单孔脊柱手术（AUSS）与微创经椎间孔腰椎椎间融合术（MIS⁃TLIF）治疗腰椎退变性疾病的临床效果及安全性。方法回顾性分析 120 例腰椎退变性疾病患者的临床资料，根据术式将其分为 AUSS组（58 例）和 MIS⁃TLIF组（62 例）。比较两组患者围手术期指标、不同时间点（术前、术后 1 d、术后1 个月、术后3 个月、术后6 个月及末次随访）的腰背部疼痛视觉模拟量表（VAS）评分及（术前、术后 1 d、术后1 个月、术后3 个月及末次随访）Oswestry 功能障碍指数（ODI）评分、影像学指标、术后并发症及不良反应发生情况。结果（1）围手术期指标：AUSS组患者的术中出血量、下床活动所需时间少于 MIS⁃TLIF组，总切口长度短于MIS⁃TLIF组，手术时间长于 MIS⁃TLIF组（P<0.05）；两组患者术后住院时间差异无统计学意义（P>0.05）。（2）腰背部疼痛VAS评分及ODI评分：术后 1 d、术后 1 个月，AUSS组患者的腰背部疼痛VAS评分低于MIS⁃TLIF组，末次随访，MIS⁃TLIF组患者的腰背部疼痛VAS评分低于AUSS组（P<0.05）；术后 3 个月、末次随访，MIS⁃TLIF组患者的ODI评分低于AUSS组（P<0.05）。（3）影像学指标：两组患者的椎间隙高度改善程度、椎间孔高度改善程度差异无统计学意义（P>0.05）；AUSS组患者的融合情况优于 MIS⁃TLIF组（P<0.05），其中AUSS组的Ⅰ级融合率更高。（4）安全性指标：两组患者的并发症及不良反应发生率差异无统计学意义（P>0.05）。结论在腰椎退变性疾病的治疗中，AUSS具有微创优势，术后早期疼痛缓解更明显，而MIS⁃TLIF的远期功能改善更优，且二者安全性相当，临床应根据患者实际情况进行选择。

Objective To compare the clinical effect and safety of arthroscopic⁃assisted uni⁃portal spinal surgery (AUSS) with minimally invasive surgery⁃transforaminal lumbar interbody fusion (MIS⁃TLIF) in treating lumbar degenerative diseases. Methods A retrospective analysis was conducted on clinical data of 120 patients with lumbar degenerative diseases. Patients were divided into AUSS group (58 cases) or MIS⁃TLIF group (62 cases) according to surgical approaches. Perioperative indicators, Visual Analogue Scale (VAS) score (before surgery, 1 day and 1, 3, 6 months after surgery, as well as the last follow⁃up) for lumbodorsal pain and Oswestry disability index (ODI) score (before surgery, 1 day and 1, 3 months after surgery, as well as the last follow⁃up) at different time points, imaging indices, as well as postoperative complications and adverse reactions were compared between the two groups. Results (1) Perioperative indicators: the AUSS group exhibited less intraoperative bleeding volume, and shorter out⁃of⁃bed time, a shorter total incision length, and longer operation duration compared to the MIS⁃TLIF group (P<0.05), but there was no statistically significant difference in length of hospital stay after surgery between the two groups (P>0.05). (2) VAS score for lumbodorsal pain and ODI score: the AUSS group interpreted a lower VAS score for lumbodorsal pain 1 day and 1 month after surgery compared to the MIS⁃TLIF group; furthermore, at the last follow⁃up, VAS score for lumbodorsal pain was lower in the MIS⁃TLIF group than in the AUSS group (P<0.05). ODI score was lower in the MIS⁃TLIF group than in the AUSS group 3 months after surgery and at the last follow⁃up (P<0.05). (3) Imaging indices: there was no statistically significant difference in improvement degree of intervertebral space height and intervertebral foramen height between the two groups (P>0.05). The AUSS group depicted superior fusion condition to the MIS⁃TLIF group (P<0.05), therein the grade Ⅰ fusion rate was higher in the AUSS group. (4) Safety indices: there was no statistically significant difference in the incidence rates of complications and adverse reactions between the two groups (P>0.05). Conclusion In the treatment of lumbar degenerative diseases, AUSS has the advantage of minimally invasive, and the early postoperative pain relief is more obvious. However, the long⁃term functional improvement of MIS⁃TLIF is superior. The safety of the two methods is similar, and the clinical choice should be individualized according to the patient's actual conditions.