[1]柴鑫贾帅军王瑞国曾玉红①姜超张晓勃李志琳②周江军③宋恩④许正伟**张正平**.关节镜辅助单孔脊柱手术与后路切开手术治疗退行性腰椎滑脱症的比较[J].中国微创外科杂志,2026,01(6):348-355.
　Chai Xin,Jia Shuaijun,Wang Ruiguo,et al.Comparison Between Arthroscopicassisted Uniportal Spinal Surgery and Posterior Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis[J].Chinese Journal of Minimally Invasive Surgery,2026,01(6):348-355.
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关节镜辅助单孔脊柱手术与后路切开手术治疗退行性腰椎滑脱症的比较()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年6期
页码:
348-355
栏目:
临床研究
出版日期:
2026-06-22

文章信息/Info

Title:
Comparison Between Arthroscopicassisted Uniportal Spinal Surgery and Posterior Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis
作者:
柴鑫贾帅军王瑞国曾玉红①姜超张晓勃李志琳②周江军③宋恩④许正伟**张正平**
(西安市红会医院脊柱外科，西安710054)
Author(s):
Chai Xin;  Jia Shuaijun;  Wang Ruiguo;  et al.
Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an 710054, China
关键词:
关节镜辅助单孔脊柱手术; 后路腰椎椎间融合术; 腰椎滑脱
Keywords:
Arthroscopicassisted uniportal spinal surgery; Posterior lumbar interbody fusion; Lumbar spondylolisthesis
文献标志码:
A
摘要:
目的探讨关节镜辅助单孔脊柱手术(arthroscopicassisted uniportal spinal surgery，AUSS)与后路腰椎椎间融合术(posterior lumbar interbody fusion，PLIF)治疗退行性腰椎滑脱症(degenerative lumbar spondylolisthesis，DLS)的疗效。方法回顾2023年10月~2024年12月54例DLS资料，其中24例采用AUSS减压椎间植骨融合联合经皮椎弓根钉固定(AUSS组)，30例采用后路切开减压复位椎间植骨融合(PLIF组)。2组一般资料差异无显著性(P>0.05)。比较2组手术时间、术中出血量、术后引流量、住院时间及并发症；术前及术后2周、1个月、3个月、6个月疼痛视觉模拟评分(Visual Analogue Scale，VAS)、Oswestry功能障碍指数(Oswestry Disability Index，ODI)。末次随访采用Bridwell法评估椎间融合情况，采用改良MacNab标准评估疗效。结果与PLIF组相比，AUSS组手术时间较长［(252.8±41.3)min vs. (129.3±10.0)min，P=0.000］，但术中出血量［(128.0±21.5)ml vs. (172.9±26.7)ml］、术后引流量［(104.5±16.7)ml vs. (162.6±22.2)ml］、住院时间［(8.4±1.6)d vs. (11.0±1.6)d］均明显减少(均P=0.000)。AUSS组无并发症发生，PLIF组硬膜囊撕裂3例、一过性L5神经根麻痹1例。2组随访时间6~12个月［(9.8±2.5)月］。2组术后各时点疼痛VAS评分、ODI均较术前明显改善(P<005)，AUSS组术后2周［(2.6±0.7)分vs.(3.8±0.7)分］、1个月［(1.8±0.4)分vs.(3.2±0.5)分］、3个月［(1.3±0.6)分vs.(2.0±0.2)分］VAS评分低于PLIF组(均P=0.000)，术后2周［(24.8±2.5)% vs.(35.7±2.5)%］、1个月［(22.2±2.3)% vs.(31.2±2.7)%］、3个月［(16.7±1.8)% vs.(23.3±1.9)%］、6个月［(10.8±1.4)% vs.(15.4±1.5)%］ODI均低于PLIF组(均P=0.000)。末次随访2组均为BridwellⅠ级、Ⅱ级融合，2组椎间融合情况、改良MacNab疗效评价和滑脱复位率［(92.8±2.3)% vs. (91.8±3.3)%］差异均无显著性(均P>0.05)。结论与经典的PLIF相比，AUSS治疗DLS虽然手术时间较长，但出血少，恢复快，并发症少，且疗效相同。
Abstract:
ObjectiveTo compare the clinical efficacy of arthroscopicassisted uniportal spinal surgery (AUSS) and posterior lumbar interbody fusion (PLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS).MethodsClinical data of 54 cases of DLS from October 2023 to December 2024 were retrospectively analyzed, including 24 patients undergoing AUSS for decompression, interbody bone graft fusion, and percutaneous pedicle screw fixation (AUSS group), and 30 patients undergoing posterior open decompression, reduction, and interbody bone graft fusion (PLIF group). There was no significant difference in the general data between the two groups (P>0.05), and the two groups were compared regarding operative time, intraoperative blood loss, postoperative drainage volume, hospital stay, and complications. The pain Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) were assessed preoperatively and at 2 weeks, 1 month, 3 months, and 6 months postoperatively. At the final followup, interbody fusion was evaluated by the Bridwell grading system, and clinical outcomes were assessed by using the modified MacNab criteria.ResultsCompared to the PLIF group, the AUSS group had a longer operative time ［(252.8±41.3) min vs. (129.3±10.0) min, P=0.000］, less intraoperative blood loss ［(128.0±21.5) ml vs. (172.9±26.7) ml, P=0.000］, less postoperative drainage ［(104.5±16.7) ml vs. (162.6±22.2) ml, P=0.000］, and shorter postoperative hospital stay ［(8.4±16) d vs. (11.0±1.6) d, P=0.000］. No complications occurred in the AUSS group, while the PLIF group experienced 3 cases of dural sac tear and 1 case of transient L5 nerve root paralysis. The followup period for both groups ranged from 6 to 12 months ［mean, (9.8±2.5) months］. The VAS scores and ODI at all postoperative time points were significantly improved compared to preoperative values in both groups (P<0.05). The AUSS group had significantly lower VAS scores at 2 weeks ［(2.6±0.7) vs. (3.8±0.7)］, 1 month ［(1.8±0.4) vs. (3.2±0.5)］, and 3 months postoperatively ［(1.3±0.6) vs. (2.0±0.2)］ (all P=0.000) and significantly lower ODI at 2 weeks ［(24.8±2.5)% vs. (35.7±2.5)%］, 1 month ［(222±2.3)% vs. (31.2±2.7)%］, 3 months ［(16.7±1.8)% vs. (23.3±1.9)%］, and 6 months postoperatively ［(10.8±1.4)% vs. (15.4±1.5)%］ compared to the PLIF group (all P=0.000). At the final followup, all the patients in both groups achieved Bridwell grade Ⅰ or Ⅱ fusion. No statistically significant differences were found between the two groups in terms of interbody fusion grade, modified MacNab criteria outcome, or spondylolisthesis reduction rate ［(92.8±2.3)% vs. (91.8±3.3)%］ (all P>005).Conclusion Compared with conventional PLIF, the treatment of DLS with AUSS, although requiring a longer operative time, results in less blood loss, faster recovery, and fewer complications, while achieving comparable clinical efficacy.

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备注/Memo

备注/Memo:
基金项目：陕西省自然科学基础研究计划(2023-JC-YB-814)**通讯作者，Email：wzzppzz@qq.com(张正平)；irenewayne@126.com(许正伟)①(西安市红会医院骨质疏松科，西安710054)②(四川省广元市中心医院骨科，广元628000)③(中国人民解放军联勤保障部队第九〇八医院骨科，南昌330000)④(昆明医科大学第一附属医院运动医学科，昆明650021)
更新日期/Last Update: 2026-06-22