微创医学

目的比较单侧双通道内镜下经椎间孔腰椎椎间融合术（UBE-TLIF）与微创通道下经椎间孔腰椎椎间融合术（MIS-TLIF）治疗老年单节段退行性腰椎滑脱症（DLS）的临床疗效。方法回顾性分析94例老年单节段DLS患者的临床资料，根据手术方式的不同，将患者分为UBE-TLIF组（n=45）， MIS-TLIF组（n=49）。比较两组患者手术时间、术中出血量；术前及术后1周、1个月、3个月和1年，分别比较两组患者的疼痛视觉模拟评分法（VAS）评分及Oswestry功能障碍指数（ODI）评分；术前和术后1年，采用健康调查简表（SF-36）评估两组患者的生活质量；观察并记录两组患者切口感染、硬膜囊撕裂、颅内压增高及硬膜外血肿、残留神经症状等并发症的发生情况；术后3个月，比较两组患者的腰椎滑脱复位率及椎间融合情况。结果 UBE-TLIF组患者手术时间长于MIS-TLIF组，术中出血量少于MIS-TLIF组（P<0.05）；术后1周，UBE-TLIF组患者疼痛VAS评分、ODI评分低于MIS-TLIF组；术后1个月、3个月和1年，两组患者疼痛VAS评分、ODI评分低于术前（P<0.05）；术后1年，两组患者SF-36评分高于术前（P<0.05），但两组患者SF-36评分差异无统计学意义（P>0.05）；两组患者术后总并发症发生率、腰椎滑脱复位率、椎间融合情况差异无统计学意义（P>0.05）。结论 UBE-TLIF与MIS-TLIF两种术式治疗老年单节段DLS均可以缓解患者疼痛，改善腰椎功能，提高生活质量，但UBE-TLIF术中出血量更少，可以更早地促进患者恢复，临床上应根据患者的具体情况选择合适的术式。

Objective To compare the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of elderly patients with single-segment degenerative lumbar spondylolisthesis (DLS). Methods Clinical data of 94 elderly patients with single-segment DLS were retrospectively analyzed and divided into UBE-TLIF group (n=45) and MIS-TLIF group (n=49) according to surgical approach. The operative duration and intraoperative blood loss were compared between the two groups. The pain visual analogue scale (VAS) and Oswestry disability index (ODI) scores were assessed preoperatively and at 1 week, 1 month, 3 months and 1 year postoperatively. The MOS 36-item short-form health survey (SF-36) was used to evaluate the quality of life of the two groups preoperatively and at 1 year postoperatively. Complications including incision infection, dural tear, increased intracranial pressure, epidural hematoma and residual neurological symptoms were recorded. At 3 months postoperatively, the reduction rate of lumbar spondylolisthesis and interbody fusion were compared between the two groups. Results The UBE-TLIF group had a longer operative duration but less intraoperative blood loss than the MIS-TLIF group (P<0.05). At 1 week postoperatively, the pain VAS and ODI scores were lower in the UBE-TLIF group than in the MIS-TLIF group (P<0.05). At 1 month, 3 months and 1 year postoperatively, the pain VAS and ODI scores in both groups were significantly lower than the preoperative levels (P<0.05). SF-36 scores increased significantly in both groups at 1 year postoperatively (P<0.05), with no statistically significant intergroup difference (P>0.05). No statistically significant differences were found in overall complication rate, spondylolisthesis reduction rate or interbody fusion between the two groups (P>0.05). Conclusion Both UBE-TLIF and MIS-TLIF yield comparable therapeutic efficacy for elderly patients with single-segment DLS, as evidenced by significant pain relief, improved lumbar function and enhanced quality of life. Nevertheless, UBE-TLIF results in less intraoperative blood loss and facilitates earlier postoperative recovery. Therefore, individualized surgical selection should be performed according to patients' clinical characteristics.