TESSYS和ULESS经皮椎间孔镜手术治疗腰椎管狭窄伴I度退行性椎体滑移的长期随访对比性研究

Comparisons of percutaneous transforaminal endoscopic lumbar discectomy with TESSYS and ULESS procedures for the treatment of spinal lumbar stenosis with low-grade spondylolisthesis

摘要:

目的：对比经皮椎间孔镜（transforaminal endoscopic lumbar discectomy，PELD）T路（transforaminal endoscopic spine system，TESSYS）和U路（underlaminar endoscopic surgical system，ULESS）治疗腰椎管狭窄伴I度退行性椎体滑移患者的临床疗效和长期预后。方法：纳入诊断为“腰椎管狭窄伴I度椎体滑移”患者并在我科接受PELD治疗患者，其中42例接受TESSYS（T组）、53例接受ULESS（U组）。记录患者年龄、性别、手术时间、并发症、住院天数等，在术前、术后1天、7天、1月、3月、6月、1年和2年进行随访。采用视觉模拟量表（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry Disability Index，ODI）腰痛、下肢痛和生活质量，最后一次随访中采用改良Macnab标准评估患者临床预后。结果：T组和U组患者年龄、性别构成、症状持续时间、手术时间和住院天数等无显著差异（P>0.05）。两组术后腰痛和下肢痛VAS疼痛评分、ODI指数评分均显著低于术前（P?0.01），但是两组各时间点间无显著差异（P>0.05）。T组失访患者3名，因此共有92名患者完成本研究所有随访。最后一次随访T组和U组改良Macnab评估“优良率”分别达92.3%和98.1%，两组间无显著差异（P>0.05）。随访期间，两组均未报告任何形式并发症。结论：T路和U路PELD手术方式均为治疗“腰椎管狭窄伴I度退行性椎体滑移”患者安全、有效的方法。

Abstract:

Objectives: To assess the effectiveness and safety of different procedures of transforaminal endoscopic lumbar discectomy (PELD) between the transforaminal endoscopic spine system (TESSYS) and underlaminar endoscopic surgical system (ULESS) in lumbar spinal stenosis (LSS) with low-grade DS patients. Methods: Patients diagnosed as LSS with grade I spondylolisthesis were identified from a list of patients scheduled to undergo PELD surgery in our department. Forty-two participants received PELD with TESSYS (T group), and 53 received PELD with ULESS (U group). The authors recorded the operation time, the duration of staying at the hospital and complication incidences. Participants rated back and leg pain intensities and completed Oswestry Disability Index (ODI) at each visit time points pre- and post-operation (1-day, 7-day, 1-month, 3-month, 6-month, 1-year and 2-year). All the patients finished modified Macnab evaluation at the final visit in addition to VAS and ODI. Results: There was no significance of in the operation time, hospital stay or incidence of complications between the 2 groups (P>0.05). Both U and T groups presented significant reductions in back and leg pain intensity, and the ODI scores after surgery (P ?0.01). Three participants in the T group were lost to the follow-up, thus, totally 92 patients completed the study. Rates of patient satisfaction reached 92.3% and 98.1% in the T and U group, respectively (P>0.05). No report of complication during the follow up period was recorded. Conclusion: Our results suggest that both PELD with TESSYS and ULESS procedures are safe and effective alternatives to open surgery for treating LSS with grade I spondylolisthesis and both methods seem to yield identical outcomes.