经皮单轴全内镜下腰椎融合术治疗老年腰椎退行性疾病的早期疗效观察

doi:10.3969/j.issn.1003-9198.2025.06.011

摘要/Abstract

摘要： 目的探讨经皮单轴全内镜下后路经椎板间隙腰椎椎间融合术(Endo-PLIF)治疗老年腰椎退行性疾病的早期临床效果。方法回顾性分析2021年5月至2022年5月东南大学附属中大医院脊柱中心接受Endo-PLIF治疗的40例病人,收集手术时间、术中出血量、术后住院时间及并发症发生情况等资料。术前和术后1、6、12个月时,采用Oswestry功能障碍指数(ODI)评估腰椎功能,采用VAS评估病人腰部及腿部疼痛。术前及术后12个月采用CT测量手术节段的椎管横断面积。术前、术后即刻,以及术后1、6、12个月采用X线片测量椎间隙高度,并于术后12个月时评估椎间隙是否骨性融合。结果所有病人均顺利完成手术,手术时间为(223.1±37.4)min,术中出血量为(83.3±28.9)mL,术后住院时间为(6.3±1.4)d。病人术后1、6、12个月的腰部腿部VAS评分及ODI均较术前显著降低(P＜0.05),术后腰椎椎管面积显著大于术前(P＜0.05)。术后即刻及随访各时间段腰椎椎间隙高度均较术前显著增高,差异有统计学意义(P＜0.05),而且术后随访各时间点椎间隙高度基本稳定,未见明显塌陷。术后12个月随访时椎间融合率为95％。结论 Endo-PLIF创伤小,恢复快,治疗老年腰椎退行性疾病安全可靠,早期疗效满意。

关键词: Delta大通道, 腰椎融合术, 内窥镜, 老年人, 腰椎退行性疾病

Abstract: Objective To investigate the early clinical outcomes of percutaneous single-axis full-endoscopic posterior lumbar interbody fusion (Endo-PLIF) in the treatment of lumbar degenerative disease in the elderly. Methods A retrospective analysis was conducted on 40 patients who underwent Endo-PLIF in Spinal Center of Zhongda Hospital Southeast University from May 2021 to May 2022. The data including operative time, intraoperative blood loss, postoperative hospital stay, and the incidence of complications were collected. The lumbar function was evaluated using Oswestry Disability Index (ODI) before operation and 1, 6, and 12 months after operation. Visual Analog Scale (VAS) was used to evaluate the pain at the lumbar region and leg. The cross-sectional area of the spinal canal at the surgical segment was measured using CT scans before operation and 12 months after operation. Lumbar disc height was measured using X-ray films before operation, immediately after operation, and 1, 6, and 12 months after operation. The bony fusion of the intervertebral space was assessed 12 months after operation. Results All patients successfully underwent the surgery. The operative time was 223.1±37.4 minutes, and the intraoperative blood loss was 83.3±28.9 mL, and the postoperative hospital stay was 6.3±1.4 d. The scores of VAS at the lumbar region and leg and ODI 1, 6, and 12 months after surgery were significantly lower than those before surgery (P<0.05). The cross-sectional area of the spinal canal significantly increased postoperatively (P<0.05). Lumbar disc height was significantly higher at all follow-up time points than that before surgery (P<0.05), and remained stable without significant collapse. The intervertebral fusion rate was 95% 12 months after operation. Conclusions Endo-PLIF is minimally invasive and associated with rapid recovery. It is a safe and reliable treatment for lumbar degenerative disease in the elderly, with satisfactory early clinical outcomes.

Key words: Delta large channel, lumbar fusion, endoscopy, aged, lumbar degenerative disease

中图分类号:

R681.57

张培, 宋鹏, 刘军. 经皮单轴全内镜下腰椎融合术治疗老年腰椎退行性疾病的早期疗效观察[J]. 实用老年医学, 2025, 39(6): 586-590.

ZHANG Pei, SONG Peng, LIU Jun. Early efficacy of percutaneous endoscopic posterior lumbar interbody fusion in the treatment of lumbar degenerative diseases in the elderly[J]. Practical Geriatrics, 2025, 39(6): 586-590.

参考文献

[1] 吴云霞, 刘忠军, 刘晓光, 等. 2008～2014年北医三院骨科脊柱退行性疾病的住院人群特征分析[J]. 中国脊柱脊髓杂志, 2016, 26(1): 70-76.
[2] SCHLEGEL K F, PON A. The biomechanics of posterior lumbar interbody fusion (PLIF) in spondylolisthesis[J]. Clin Orthop Relat Res, 1985(193): 115-119.
[3] PLANTZ M A, HSU W K. Single-levelposterolateral fusion (PLF) alone and posterior interbody fusion (PLIF/TLIF) alone lead to a decreased risk of short-term complications compared to combined PLF with PLIF/TLIF procedures: a matched analysis[J]. Spine: Phila Pa 1976, 2020, 45(21): E1391-E1399.
[4] KAMALANATHAN V, KIEFFER W K M, ZHU M, et al.Lordosis recreation with PLIF surgery-what is the influence on adjacent segment lordosis? :an observational study of radiological alignment change[J]. Spine: Phila Pa 1976, 2020, 45(17): 1178-1184.
[5] ALOBAIDAAN R, COHEN J R, LORD E L, et al.Complication rates in posterior lumbar interbody fusion (PLIF) surgery with human bone morphogenetic protein 2: medicare population[J]. Global Spine J, 2017, 7(8): 770-773.
[6] HARMS J G, JESZENSZKY D. Die posteriore, lumbale, interkorporelle fusion in unilateraler transforaminaler technik[J].Oper Orthop Traumatol, 1998, 10(2): 90-102.
[7] FOLEY K T, LEFKOWITZ M A. Advances in minimally invasive spine surgery[J]. Clin Neurosurg, 2002, 49: 499-517.
[8] MCAFEE P C, BODEN S D, BRANTIGAN J W, et al. Symposium: acritical discrepancy-acriteria of successful arthrodesis following interbody spinal fusions[J]. Spine: Phila Pa 1976, 2001, 26(3): 320-334.
[9] 王建, 周跃, 初同伟, 等. 改良内窥镜下行后路腰椎间融合和经皮椎弓根螺钉固定治疗腰椎退变性疾患[J]. 中国脊柱脊髓杂志, 2007, 17(12): 908-912.
[10] LIANG Z Y, ZHUANG Y D, CHEN C M, et al.Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial[J]. BMJ Open, 2019, 9(12): e033888.
[11] 蒋勇,何升华,赖居易,等.经皮脊柱内镜两种入路治疗L5S1椎间盘突出症的疗效分析[J].中国骨伤,2020,33(5):406-413.
[12] SINGHATANADGIGE W, PROMSUWAN M, TANASANSOMBOON T, et al.Is unilateral minimally invasive transforaminal lumbar interbody fusion sufficient in patients with claudication? A comparative matched cohort study[J]. World Neurosurg, 2021, 150: e735-e740.

[1]	范慢利, 韩怡. PCNE分类系统在消化内科老年病人抗生素使用中的应用效果[J]. 实用老年医学, 2025, 39(6): 565-569.
[2]	刘文秀, 郑美洁, 李伟, 陈紫叶, 孟琼, 李贤. 呼吸运动康复操-认知双重训练对老年COPD合并认知障碍病人呼吸功能和认知功能的影响[J]. 实用老年医学, 2025, 39(6): 577-581.
[3]	鲁爽, 汪杰, 孙苗, 刘永平, 张凯丽, 廖鹏斌. 血清lncRNA NEAT1、SIRT2水平与老年急性缺血性脑卒中病人病情及预后的关系[J]. 实用老年医学, 2025, 39(6): 595-600.
[4]	杨斌, 叶青, 邓天瑞, 徐韵婷, 许慧清, 敖国凤, 唐伟, 徐斐. 南京地区老年糖尿病病人新冠疫情期间及之后健康相关生活质量的比较分析[J]. 实用老年医学, 2025, 39(6): 606-610.
[5]	张友嘉, 谢海, 冉峰. 老年下肢动脉硬化闭塞症病人肠道及斑块菌群特征的探索研究[J]. 实用老年医学, 2025, 39(6): 611-616.
[6]	朱相瑜, 杭乐佳, 王宇, 吴予一, 赵一菁, 朱蓓, 黄菁菁. 人工智能在老年心血管疾病中的应用研究进展[J]. 实用老年医学, 2025, 39(6): 621-625.
[7]	杨光, 陈玉红, 冯萍, 李锡涵, 李格. 基于早期预警评分的临床决策支持系统在老年急性主动脉夹层病人中的应用[J]. 实用老年医学, 2025, 39(6): 636-640.
[8]	甘宇婧, 黄敏. 老年重症病人营养治疗并发症处理[J]. 实用老年医学, 2025, 39(5): 433-438.
[9]	周静. 老年重症病人营养治疗时机和途径选择[J]. 实用老年医学, 2025, 39(5): 439-443.
[10]	江洁, 周丹丹, 朱宝华. 老年重症病人能量和蛋白质供给目标研究进展[J]. 实用老年医学, 2025, 39(5): 444-449.
[11]	段剑锋, 虞文魁. 肠道菌群与老年危重症[J]. 实用老年医学, 2025, 39(5): 450-455.
[12]	张杰, 汪奇峰, 密玮诺, 张丽娜, 陈国芳, 孙宇, 徐书杭, 刘超. 农村老年人维生素D水平与自身免疫性甲状腺炎的横断面研究[J]. 实用老年医学, 2025, 39(5): 456-460.
[13]	张扬, 杨顺, 臧刘雪, 陆咨儒, 于震峰, 刘美玉. 罗哌卡因复合不同浓度亚甲蓝行髂筋膜阻滞对髋关节置换术病人术后镇痛和康复效果的影响[J]. 实用老年医学, 2025, 39(5): 466-471.
[14]	霍晓鹏, 李洋, 赵亚芳, 李超跃, 赖小星. 社区认知衰弱老年人抑郁现状及影响因素分析[J]. 实用老年医学, 2025, 39(5): 477-481.
[15]	王国余, 许岑, 王健, 王如珠. 老年急性ST段抬高型心肌梗死病人营养不良风险与PCI术后预后的关系[J]. 实用老年医学, 2025, 39(5): 482-486.