关节镜辅助单孔脊柱手术与微创经椎间孔腰椎椎间融合术治疗腰椎退变性疾病的临床效果及安全性比较OA

Objective To compare the clinical effect and safety of arthroscopic-assisted uni-portal spinal surgery(AUSS)with minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF)in treating lumbar degenerative diseases.Methods A retrospective analysis was conducted on clinical data of 120 patients with lumbar degenerative diseases.Patients were divided into AUSS group(58 cases)or MIS-TLIF group(62 cases)according to surgical approaches.Perioperative indicators,Visual Analogue Scale(VAS)score(before surgery,1 day and 1,3,6 months after surgery,as well as the last follow-up)for lumbodorsal pain and Oswestry disability index(ODI)score(before surgery,1 day and 1,3 months after surgery,as well as the last follow-up)at different time points,imaging indices,as well as postoperative complications and adverse reactions were compared between the two groups.Results(1)Perioperative indicators:the AUSS group exhibited less intraoperative bleeding volume,and shorter out-of-bed time,a shorter total incision length,and longer operation duration compared to the MIS-TLIF group(P<0.05),but there was no statistically significant difference in length of hospital stay after surgery between the two groups(P>0.05).(2)VAS score for lumbodorsal pain and ODI score:the AUSS group interpreted a lower VAS score for lumbodorsal pain 1 day and 1 month after surgery compared to the MIS-TLIF group;furthermore,at the last follow-up,VAS score for lumbodorsal pain was lower in the MIS-TLIF group than in the AUSS group(P<0.05).ODI score was lower in the MIS-TLIF group than in the AUSS group 3 months after surgery and at the last follow-up(P<0.05).(3)Imaging indices:there was no statistically significant difference in improvement degree of intervertebral space height and intervertebral foramen height between the two groups(P>0.05).The AUSS group depicted superior fusion condition to the MIS-TLIF group(P<0.05),therein the grade Ⅰ fusion rate was higher in the AUSS group.(4)Safety indices:there was no statistically significant difference in the incidence rates of complications and adverse reactions between the two groups(P>0.05).Conclusion In the treatment of lumbar degenerative diseases,AUSS has the advantage of minimally invasive,and the early postoperative pain relief is more obvious.However,the long-term functional improvement of MIS-TLIF is superior.The safety of the two methods is similar,and the clinical choice should be individualized according to the patient's actual conditions.