两种不同的脊柱微创融合手术方式治疗腰椎退行性疾病的疗效比较研究OA

Objective To compare the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion(ULIF)and full-endoscopic posterior lumbar interbody fusion(Endo-PLIF)in treating lumbar degenerative diseases(LDD).Methods A retrospective analysis was performed on 120 patients with lumbar degenerative diseases(LDD)who received surgical treatment between January 2021 and January 2024.Patients were allocated to either the ULIF group(n=63)or the Endo-PLIF group(n=57)according to strict inclusion and exclusion criteria.Patients in the ULIF group underwent unilateral biportal endoscopic lumbar interbody fusion,while those in the Endo-PLIF group received full-endoscopic interlaminar lumbar interbody fusion with internal fixation.Intraoperative data,including incision length and estimated blood loss were recorded.Disc and foraminal heights were assessed via radiographic measurements preoperatively and at multiple postoperative time points.Clinical outcomes included VAS scores for back and leg pain,ODI scores,complication rates,patient satisfaction(evaluated by the modified MacNab criteria),and fusion status(graded using the Bridwell classification).All 120 patients successfully completed the 12-month postoperative follow-up.Results The Endo-PLIF group demonstrated significantly longer operative times and smaller incision lengths compared to the ULIF group(P<0.05).No significant difference in postoperative hospital stay was observed between the two groups(P>0.05).Three days after surgery,disc and foraminal heights were significantly greater in the ULIF group than in the Endo-PLIF group(P<0.001).Significant improvements in both VAS and ODI scores were observed in both groups compared to baseline values.The ULIF group showed greater reductions in low back pain VAS scores on postoperative day 3,as well as in leg pain VAS and ODI scores at day 3 and at 3 months after surgery(P<0.05).At the final follow-up,patient satisfaction remained high in both groups,with 96.8％in the ULIF group and 94.7％in the Endo-PLIF group.Fusion rates were 95.2％in the ULIF group and 93.0％in the Endo-PLIF group,with no statistically significant difference(P>0.05).Both procedures had low complication rates,and adverse events did not significantly differ between groups.Conclusion ULIF demonstrated advantages in early pain relief and functional recovery,along with more substantial restoration of disc and foraminal height.Conversely,Endo-PLIF was associated with reduced intraoperative soft tissue trauma.By the 12-month follow-up,both procedures achieved comparable fusion rates and patient satisfaction,supporting their equivalent efficacy.