李新武 韦华成 李昊 廖正文 魏芳芳

【摘要】 目的：比較全内镜经椎间孔腰椎椎间融合术（FE-TLIF）和微创经椎间孔腰椎椎间融合术（MI-TLIF）治疗腰椎退行性疾病（LDD）的临床效果和安全性。方法：前瞻性将2020年1月—2022年

10月在百色市人民医院因LDD接受TLIF治疗的患者60例，按随机数字表法分为FE-TLIF组（接受FE-TLIF治疗）和MI-TLIF组（接受MI-TLIF治疗），每组30例。比较两组的围手术期指标、术前和术后3个月疼痛视觉模拟评分法（VAS）评分与Oswestry功能障碍指数（ODI）评分、术后6个月及1年椎体间融合情况。结果：两组手术时间比较，差异无统计学意义（P>0.05）。FE-TLIF组术中透视次数多于MI-TLIF组，差异有统计学意义（P<0.05）。FE-TLIF组术中出血量少于MI-TLIF组，术后卧床时间、住院时间均短于MI-TLIF组，差异均有统计学意义（P<0.05）。两组患者术后VAS评分及ODI评分与术前比较均明显降低，差异均有统计学意义（P<0.05）。术后6个月及1年两组椎体间融合情况比较，差异均无统计学意义（P>0.05）。两组术后并发症发生率比较，差异无统计学意义（P>0.05）。结论：FE-TLIF与MI-TLIF在术后疼痛缓解、功能恢复、融合率方面显示出了相似的结果，但FE-TLIF在降低术中出血量，缩短术后卧床时间、住院时间上有更大优势。

【关键词】 腰椎退行性疾病 全内镜经椎间孔腰椎椎间融合术 微创经椎间孔腰椎椎间融合术

Comparison of Clinical Effects of Full Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Degenerative Diseases/LI Xinwu， WEI Huacheng， LI Hao， LIAO Zhengwen， WEI Fangfang. //Medical Innovation of China， 2024， 21（08）： 0-042

[Abstract] Objective： To compare the clinical efficacy and safety of full endoscopic transforaminal lumbar interbody fusion （FE-TLIF） and minimally invasive transforaminal lumbar interbody fusion （MI-TLIF） in the treatment of lumbar degenerative diseases （LDD）. Method： A total of 60 patients who received TLIF for LDD in Baise People's Hospital from January 2020 to October 2022 were prospectively randomized into FE-TLIF group （received FE-TLIF treatment） and MI-TLIF group （received MI-TLIF treatment）， with 30 patients in each group. Perioperative indexes， visual analogue scale （VAS） scores and Oswestry disability index （ODI） scores before and 3 months after surgery， interbody fusion 6 months and 1 year after surgery were compared between the two groups. Result： There was no significant difference in operation time between the two groups （P>0.05）. The number of intraoperative fluoroscopy in FE-TLIF group was higher than that in MI-TLIF group， the difference was statistically significant （P<0.05）. The intraoperative blood loss in FE-TLIF group was less than that in MI-TLIF group， and the postoperative bed time and hospital stay were shorter than those in MI-TLIF group， the differences were statistically significant （P<0.05）. Postoperative VAS scores and ODI scores of two groups were significantly lower than those before surgery， the differences were statistically significant （P<0.05）. There were no significant differences in interbody fusion between the two groups at 6 months and 1 year after surgery （P>0.05）. There was no significant difference in the incidence of postoperative complications between the two groups （P>0.05）. Conclusion： FE-TLIF and MI-TLIF show similar results in postoperative pain relief， functional recovery， and fusion rate， but FE-TLIF has greater advantages in reducing intraoperative blood loss， shortening postoperative bed duration， and shortening hospital stay.

[Key words] Lumbar degenerative diseases Full endoscopic transforaminal lumbar interbody fusion Minimally invasive transforaminal lumbar interbody fusion

First-author's address： Department of Spinal Orthopedics， Baise People's Hospital， Baise 533000， China

doi：10.3969/j.issn.1674-4985.2024.08.009

傳统的后路/经椎间孔腰椎椎间融合术对于腰椎退行性疾病（LDD）取得了满意的临床效果[1-2]。然而，医源性椎旁肌损伤、后张力带破坏及入路相关并发症是一个令人担忧的问题[3]。因此，包括全内镜经椎间孔腰椎椎间融合术（FE-TLIF）和微创经椎间孔腰椎椎间融合术（MI-TLIF）在内的创新手术方法已得到广泛应用[4-5]。目前FE-TLIF和MI-TLIF治疗LDD的功效已在多项研究中得到证实。然而，相关综述文献评估，由于目前已发表的研究样本量小、研究目标和评估指标的异质性及证据水平较低，很难得出FE-TLIF是否优于MI-TLIF的结论[6-8]。因此，本……