早期的腰椎副脊髓肌损伤:内镜与跨膜腰椎体融合:一个回顾性比较分析
Wenbin Xuan1, Qinghua Cheng2, Yucheng Gao1
1Department of Orthopedics, Zhongda Hospital, Southeast University School of Medicine, Dingjiaqiao 87, Nanjing, 210009, China.
Journal of orthopaedic surgery and research
|September 27, 2025
概括
透视性腰椎间体融合 (Endoscopic lumbar interbody fusion) (Endo-LIF) 显示了较少的脊柱肌损伤和较快的背部疼痛缓解,而不是形腰椎间体融合 (TLIF). 这两种手术的长期结果相似,但Endo-LIF的手术时间更长.
科学领域:
- 脊柱外科手术 脊柱外科手术
- 最少侵入性手术的方法
- 整形外科 整形外科 整形外科
背景情况:
- 内镜腰椎间体融合 (Endo-LIF) 已知在治疗腰椎脊柱狭窄症 (LSS) 中具有临床有效性和最小的侵入性.
- 关于早期手术后的副脊髓肌损伤的定量数据,将Endo-LIF与传统的跨腰椎体融合 (TLIF) 进行比较,是有限的.
- 了解肌肉损伤的差异可以为术后康复策略提供信息.
研究的目的:
- 量化比较Endo-LIF和TLIF之间的早期术后脊肌肉变化,用于单级LSS.
- 评估两种手术方法之间的临床结果的差异,包括疼痛和残疾.
- 为了评估急性肌肉创伤生物标志物和脊肌横截面积 (CSA) 变化.
主要方法:
- 追溯的队列研究,90名严重的LSS患者接受单级融合 (48 Endo-LIF,42 TLIF).
- 收集了关于人口统计,手术指标,患者报告的结果 (奥斯韦斯特里残疾指数,视觉模拟量表) 和肌肉创伤生物标志物 (肌酸激酶,C反应蛋白,红细胞沉积率) 的数据.
- 使用MRI在手术前和手术后量化副脊髓肌肉CSA (多,直立脊柱);使用半自动细分和定制算法进行分析.
主要成果:
- 与TLIF相比,Endo-LIF在手术后3天显著改善了早期的背痛缓解 (视觉模拟量表) 和奥斯威斯特里残疾指数得分.
- TLIF导致腰部肌炎的发病率更高,以及术后1日肌激酶和C-反应蛋白水平显著升高.
- 在TLIF组中,与手术方法和吸烟状况相关的横截面积减小更为明显;两组的长期功能结果相似.
结论:
- 与TLIF相比,Endo-LIF提供了优势,包括更早缓解背部疼痛,减少血流,缩短住院时间,并可能减少急性肌肉损伤.
- 这些好处被更长的操作时间和Endo-LIF的光学使用增加所抵消.
- 这两种手术技术都显示出相似的安全性和长期功能恢复,而Endo-LIF显示出相对较小程度的早期脊肌损伤.
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