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  • Title: [Comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive tubular transforaminal lumbar interbody fusion for lumbar degenerative disease].
    Author: Kong F, Zhou Q, Qiao Y, Wang W, Zhang C, Pan Q, Zhu H.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 May 15; 36(5):592-599. PubMed ID: 35570634.
    Abstract:
    OBJECTIVE: To compare the clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive tubular TLIF (MT-TLIF) in treatment of lumbar degenerative diseases. METHODS: A clinical data of 75 patients with lumbar degenerative diseases, who met the selection criteria between August 2019 and August 2020, was retrospectively analyzed, including 35 patients in the UBE- TLIF group and 40 patients in the MT-TLIF group. There was no significant difference in general data such as gender, age, body mass index, disease type and duration, and surgical segment between the two groups ( P>0.05), which was comparable. The operation time, intraoperative blood loss, hemoglobin (Hb) before operation and at 1 day after operation, the length of hospital stay, incidence of complications, and visual analogue scale (VAS) score of low back and leg pain, Oswestry Disability Index (ODI), Short-Form 36 Health Survey Scale (SF-36 scale), intervertebral disc height (IDH), sagittal Cobb angle, lumbar lordosis (LL), and the intervertebral fusion were compared between the two groups. RESULTS: Compared with MT-TLIF group, UBE-TLIF group had significantly longer operation time but less intraoperative blood loss and shorter length of hospital stay ( P<0.05). The Hb levels in both groups decreased at 1 day after operation, but there was no significant difference in the difference before and after operation between the two groups ( P>0.05). All patients were followed up, and the follow-up time was (14.7±2.5) months in the UBE-TLIF group and (15.0±3.4) months in the MT-TLIF group, with no significant difference ( t=0.406, P=0.686). In both groups, the VAS score of low back pain, VAS score of leg pain, SF-36 scale, and ODI after operation significantly improved when compared with those before operation ( P<0.05). There was no significant difference between 1 month after operation and last follow-up ( P>0.05). There was no significant difference in the VAS score of low back pain, VAS score of leg pain, and SF-36 scale between the two groups before and after operation ( P>0.05). At 1 month after operation, the ODI in the UBE-TLIF group was significantly better than that in the MT-TLIF group ( P<0.05). At 1 month after operation, IDH, Cobb angle, and LL in both groups recovered when compared with those before operation ( P<0.05), and were maintained until last follow-up ( P>0.05). There was no significant difference in the IDH, Cobb angle, and LL between the two groups at each time point ( P>0.05). Thirty-three cases (89.2%) in the UBE-TLIF group and 35 cases (87.5%) in the MT-TLIF group achieved fusion, and the difference was not significant ( χ 2=0.015, P=0.901). In the UBE-TLIF group, 1 case of intraoperative dural tear and 1 case of postoperative epidural hematoma occurred, with an incidence of 5.7%. In the MT-TLIF group, 1 case of intraoperative dural tear, 1 case of postoperative epidural hematoma, and 1 case of superficial infection of the surgical incision occurred, with an incidence of 7.5%. There was no significant difference in the incidence of complications between the two groups ( χ 2=1.234, P=1.000). CONCLUSION: Compared with MT-TLIF, UBE-TILF can achieve similar interbody fusion in the treatment of lumbar degenerative diseases, and has the advantages of smaller incision, less bleeding, and shorter length of hospital stay. 目的: 比较单侧双通道内镜下经椎间孔腰椎间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）与微创通道下TLIF（minimally invasive tubular TLIF, MT-TLIF）治疗腰椎退行性疾病的疗效。. 方法: 回顾分析2019年8月—2020年8月符合选择标准的75例腰椎退行性疾病患者临床资料，其中 UBE-TLIF组35例、MT-TLIF组40例。两组患者性别、年龄、身体质量指数、疾病类型及病程、手术节段等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。比较两组手术时间、术中失血量、术前及术后1 d血红蛋白（hemoglobin，Hb）、住院时间、并发症发生情况，以及腰痛疼痛视觉模拟评分（VAS）评分、腿痛VAS评分、Oswestry功能障碍指数（ODI）、简明健康调查量表（SF-36量表）评分，手术节段椎间盘高度（intervertebral disc height，IDH）、矢状面Cobb角和腰椎前凸角（lumbar lordosis，LL），椎间融合情况。. 结果: 与MT-TLIF组相比，UBE-TLIF组手术时间更长，但术中失血量减少、住院时间缩短（ P<0.05）。术后1 d两组Hb均有下降，但组间手术前后差值差异无统计学意义（ P>0.05）。两组患者均获随访，UBE-TLIF组随访时间为（14.7±2.5）个月，MT-TLIF组为（15.0±3.4）个月，差异无统计学意义（ t=0.406， P=0.686）。临床疗效评价指标：术后两组腰痛VAS评分、腿痛VAS评分、SF-36量表评分及ODI均较术前改善（ P<0.05）；术后1个月及末次随访间比较差异无统计学意义（ P>0.05）。手术前后各时间点两组腰痛VAS评分、腿痛VAS评分及SF-36评分比较，差异均无统计学意义（ P>0.05）；术后1个月UBE-TLIF组ODI优于MT-TLIF组（ P<0.05）。影像学评价指标：两组术后1个月IDH、Cobb角及LL均较术前改善（ P<0.05），且维持至末次随访时（ P>0.05）。手术前后各时间点两组IDH、Cobb角、LL比较，差异均无统计学意义（ P>0.05）。UBE-TLIF组33例（89.2%）、MT-TLIF组35例（87.5%）达植骨融合，差异无统计学意义（ χ 2=0.015， P=0.901）。UBE-TLIF组发生术中硬膜撕裂1例、术后硬膜外血肿形成1例，并发症发生率为5.7%；MT-TLIF组发生术中硬膜撕裂1例、术后硬膜外血肿形成1例、切口浅表感染1例，并发症发生率为7.5%。两组并发症发生率比较，差异无统计学意义（ χ 2=1.234， P=1.000）。. 结论: 与MT-TLIF相比，UBE-TILF治疗腰椎退行性疾病除能获得相似椎间融合效果外，还具有切口小、术中出血少、住院周期短等优点。.
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