中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (12): 1914-1919.doi: 10.12307/2024.061

• 骨科植入物 orthopedic implant • 上一篇    下一篇

倾向性评分匹配两种腰椎融合方案治疗单节段腰椎退行性疾病

万  健1，王  宁1，贝朝涌2，陈远明3，王洪岗1   

  1. 桂林医学院附属医院，1脊柱外科，2创伤外科，广西壮族自治区桂林市   541000；3广西医科大学第二附属医院骨科，广西壮族自治区南宁市   530007
  • 收稿日期:2023-02-20 接受日期:2023-05-09 出版日期:2024-04-28 发布日期:2023-08-23
  • 通讯作者: 王洪岗，博士，副主任医师，桂林医学院附属医院脊柱外科，广西壮族自治区桂林市 541000
  • 作者简介:万健，男，1991年生，江西省南昌市人，汉族，2017年广西中医药大学毕业，硕士，主治医师，主要从事脊柱退行性疾病的微创治疗。 王宁，男，1994年生，江西省信丰县人，汉族，2021年桂林医学院毕业，硕士，医师，主要从事骨组织工程、脊柱疾病方面的研究。
  • 基金资助:
    “十三五”国家重点研发计划项目(2019YFC0121400-005)，项目负责人：王洪岗；国家自然科学基金资助项目(81660366，82160416)，项目负责人：贝朝涌；桂林医学院教育教学研究与改革项目(JG201937)，项目负责人：贝朝涌

Two lumbar fusion regimens in treatment of single-level lumbar degenerative diseases based on propensity score matching

Wan Jian1, Wang Ning1, Bei Chaoyong2, Chen Yuanming3, Wang Honggang1   

  1. 1Department of Spine Surgery, 2Department of Trauma, Affiliated Hospital of Guilin Medical College, Guilin 541000, Guangxi Zhuang Autonomous Region, China; 3Department of Orthopedics, Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, Guangxi Zhuang Autonomous Region, China
  • Received:2023-02-20 Accepted:2023-05-09 Online:2024-04-28 Published:2023-08-23
  • Contact: Wang Honggang, MD, Associate chief physician, Department of Spine Surgery, Affiliated Hospital of Guilin Medical College, Guilin 541000, Guangxi Zhuang Autonomous Region, China
  • About author:Wan Jian, Master, Attending physician, Department of Spine Surgery, Affiliated Hospital of Guilin Medical College, Guilin 541000, Guangxi Zhuang Autonomous Region, China Wang Ning, Master, Physician, Department of Spine Surgery, Affiliated Hospital of Guilin Medical College, Guilin 541000, Guangxi Zhuang Autonomous Region, China
  • Supported by:
    National Key Research & Development Plan Project for the “13th Five Year Plan” Period, No. 2019YFC0121400-005 (to WHG); National Natural Science Foundation of China, No. 81660366, 82160416 (to BCY); Education and Teaching Research and Reform Project of Guilin Medical College, No. JG201937 (to BCY)

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摘要：


文题释义：

倾向性评分匹配：倾向评分匹配(propensity score matching，PSM)是一种统计学方法，用于处理观察研究的数据。在观察研究中，由于种种原因，数据偏差和混杂变量较多，倾向评分匹配的方法正是为了减少这些偏差和混杂变量的影响，以便对试验组和对照组进行更合理的比较。
腰椎融合技术：作为治疗腰椎相关疾病的技术，随着腰椎融合术的日益革新，随之而来也成为被大家热议的话题。在临床中选择何种腰椎融合术式的较量不曾停止，如何选择，各有利弊。


背景：国内外近年来广泛使用单侧双通道内镜技术行椎间融合，但其与微创经椎间孔入路腰椎椎体间融合(minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF)治疗腰椎退行性疾病的临床疗效对比仍较少，单侧双通道内镜技术是否是一种安全、高效的腰椎融合术式有待进一步论证。

目的：对比单侧双通道内镜腰椎椎间融合(unilateral biportal endoscopic lumbar interbody fusion，UBE-LIF)与MIS-TLIF治疗腰椎退行性疾病的临床疗效，探讨更高效的腰椎融合术式。
方法：纳入桂林医学院附属医院2020年10月至2022年2月收治的单节段腰椎退行性疾病患者，其中行UBE-LIF的患者35例，行MIS-TLIF的患者286例，采用倾向性评分匹配消除混杂因素，选取性别、年龄、疾病类型、手术节段4个协变量进行1∶1(卡钳值为0.01)匹配，匹配后两组各29例患者纳入研究。比较两组患者围术期中手术时间、血红蛋白丢失量、住院时间；采用目测类比和功能障碍指数对两组患者术前、术后1个月、术后半年、术后1年的功能恢复效果进行评价；末次随访采用改良MacNab标准评定两组疗效的优良率，采用Lenke腰椎骨性融合动态X射线片评估两组的植骨融合情况。

结果与结论：①在手术时间上MIS-TLIF组短于UBE-LIF组(P < 0.05)，MIS-TLIF组术中血红蛋白丢失量高于UBE-LIF组、住院时间长于UBE-LIF组，差异有显著性意义(P < 0.05)；②两组患者术后1个月、术后半年、术后1年的腰痛目测类比评分、腿痛目测类比评分及Oswestry功能障碍指数相较于术前均有显著降低(P < 0.05)；除了术后1个月腰痛目测类比评分，在以上各时间节点随访两组腰痛、腿痛目测类比评分及Oswestry功能障碍指数无明显差异(P > 0.05)；③末次随访改良MacNab标准疗效评定结果显示，UBE-LIF组优良率为93%(27/29)；MIS-TLIF组优良率为90%(26/29)，两组差异无显著性意义(P > 0.05)；④Lenke腰椎骨性融合动态X射线片评估系统进行评定后，UBE-LIF组A级21例，B级5例，C级3例，融合率为90%；MIS-TLIF组A级20例，B级5例，C级4例，融合率为86%，两组差异无显著性意义(P > 0.05)；⑤提示UBE-LIF与MIS-TLIF两种术式治疗单节段腰椎退行性疾病的临床疗效相近，均具有创伤小、出血少、住院时间短的优点；此外，UBE-LIF术后早期腰痛相对较轻，学习曲线相对平缓，虽然UBE-LIF组的手术时间较MIS-TLIF长，仍不失为一张安全、高效的术式。

https://orcid.org/0009-0007-8857-4146 (万健)；https://orcid.org/0000-0003-3826-7213 (王宁) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 单侧入路双通道内镜, 微创, 经椎间孔入路, 腰椎椎体间融合术, 临床疗效

Abstract: BACKGROUND: Unilateral biportal endoscopic technique has been widely used in lumbar interbody fusion in recent years, but there is little comparison between its clinical efficacy and that of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative disease, whether the unilateral biportal endoscopic technique is a safe and effective lumbar fusion remains to be further demonstrated.
OBJECTIVE: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) and MIS-TLIF in the treatment of lumbar degenerative diseases and explore a more efficient lumbar fusion procedure.
METHODS: Patients with single-level lumbar degenerative disease were enrolled in Affiliated Hospital of Guilin Medical College from October 2020 to February 2022, including 35 patients who underwent UBE-LIF and 286 patients who underwent MIS-TLIF. Propensity score matching was used to eliminate confounders. Four covariates including sex, age, disease type and surgical segment were matched 1:1 (caliper value 0.01). After matching, 29 patients from each group were included in the study. The perioperative operative time, hemoglobin loss and hospital stay were compared between the two groups. Visual analog scale score and Oswestry disability index were used to evaluate the functional recovery of the two groups before, 1, 6 months and 1 year after operation. The excellent and good rate of the two groups was evaluated by the modified MacNab standard at the last follow-up. The fusion of the two groups was evaluated by Lenke Dynamic X-ray film.
RESULTS AND CONCLUSION: (1) The operative time in the MIS-TLIF group was shorter than that in the UBE-LIF group (P < 0.05). The amount of intraoperative hemoglobin loss in the MIS-TLIF group was higher than that in the UBE-LIF group. The hospital stay in the MIS-TLIF group was longer than that in the UBE-LIF group, and the differences were statistically significant (P < 0.05). (2) The visual analog scale scores for lumbago and leg pain, and Oswestry disability index were significantly reduced in both groups 1, 6 months, and 1 year after surgery compared to before surgery (P < 0.05). Except for the visual analog scale score for lumbago at 1 month after surgery, there was no significant difference in the visual analog scale score for lumbago and leg pain, and Oswestry disability index between the two groups at the above time points (P > 0.05). (3) At the last follow-up, the modified MacNab standard efficacy evaluation showed that the excellent and good rates were 93% (27/29) in the UBE-LIF group and 90% (26/29) in the MIS-TLIF group; there was no significant difference between the two groups (P > 0.05). (4) Lenke dynamic radiographic evaluation system evaluation for lumbar fusion exhibited that the fusion rate was 90% (grade A, 21 cases; grade B, 5 cases; grade C, 3 cases) in the UBE-LIF group; the fusion rate was 86% (grade A, 20 cases; grade B, 5 cases; grade C, 4 cases) in the MIS-TLIF group; there was no significant difference between the two groups (P > 0.05). (5) It is indicated that UBE-LIF and MIS-TLIF have similar clinical effects in the treatment of single-level lumbar degenerative disease with the advantages of less trauma, less bleeding and shorter hospital stay. In addition, the early postoperative lumbago was relatively mild and the learning curve was relatively smooth. Although the operative time in the UBE-LIF group was longer than that in the MIS-TLIF group, it was still a safe and effective operation.

Key words: unilateral biportal endoscopy, minimally invasive, transforaminal approach, lumbar interbody fusion, clinical efficacy

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