摘要
目的比较三维导航辅助Quadrant通道下微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)与C形臂X线机透视下行MIS-TLIF治疗腰椎退行性疾病的置钉偏出方向及程度,并探讨三维导航在MIS-TLIF中的应用价值。方法回顾性分析2017年12月-2018年12月接受MIS-TLIF治疗的108例腰椎退行性疾病患者临床资料,术中采用三维导航辅助58例(导航组),采用C形臂X线机透视辅助50例(透视组)。收集2组患者的基本信息、手术时间、术中出血量,通过术后CT扫描与三维重建记录螺钉穿破骨皮质位置并测量穿透皮质距离。结果2组患者年龄、性别、体质量指数、术前诊断及手术节段构成比差异无统计学意义(P>0.05)。导航组比透视组手术时间短、术中出血少,差异有统计学意义(P<0.05)。导航组共置钉272枚,皮质穿破率为9.9%;透视组共置钉236枚,皮质穿破率为22.5%,组间差异有统计学意义(P<0.05)。导航组内、外、前侧皮质及椎间孔穿破率分别为4.8%、1.5%、3.3%和0.3%,4个方向穿破率均低于透视组的8.5%、8.5%、4.7%和0.8%,但仅内、外侧皮质穿破率差异有统计学意义(P<0.05)。2组的螺钉穿破率除2级外,其他各级差异均有统计学意义(P<0.05)。2组患者术后6个月及末次随访时腰痛、下肢痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)均较术前显著改善,差异有统计学意义(P<0.05),各时间点组间比较差异无统计学意义(P>0.05)。结论与C形臂X线机透视下MIS-TLIF相比,导航辅助MIS-TLIF治疗腰椎退行性疾病从手术节段定位、钉道制备、椎管减压到融合器置入,全程提供三维影像,能提升整体置钉精确度,降低内、外侧皮质穿破率,具有手术时间短、出血量少、并发症少的特点,可以获得安全、有效的治疗结果。
Objective To compare the position and the grade of screw perforation in Quadrant system-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) with 3D navigation techniques and C-arm fluoroscopy for degenerative lumbar disease,and to explore the advantages and superiority of 3D navigation-guided MIS-TLIF.MethodsFrom December 2017 to December 2018,a total of 108 cases of degenerative lumbar disease with MIS-TLIF were enrolled in this retrospective study.Fifty-eight MIS-TLIF cases were assisted with 3D navigation techniques(navigation group) and another 50 cases received MIS-TLIF with C-arm fluoroscopy(fluoroscopy group).In the 2 groups,the clinical information,operation time and intraoperative blood loss were all recorded.Postoperative CT scans and 3D reconstruction were used to analyze the accuracy of pedicle screw placement,and the length and position of cortical perforation.Results There was no statistical difference between the 2 groups in age,gender,body mass index,preoperative diagnosis and operative segments.Compared with fluoroscopy group,the operation time and the intraoperative blood loss showed statistically significant decrease in the navigation group(P < 0.05).There were 272 pedicle screws implanted in the navigation group,with the cortical perforation rate of 9.9%;236 nails in the fluoroscopy group,with the cortical perforation rate of 22.5%.There was a significant difference between the 2 groups(P < 0.05).The perforation rates of the inner,outer,anterior cortex and intervertebral foramen in the navigation group were 4.8%,1.5%,3.3% and 0.3%,respectively,which were lower than those in the fluoroscopy group(8.5%,8.5%,4.7% and 0.8%,respectively),but only the differences between the inner and outer cortex were statistically significant(P < 0.05).The grade 3 penetration rate(penetration distance > 4 mm) of navigation group was 1.1%,which was significantly lower than that of fluoroscopy group(4.6%,P < 0.05).The visual analogue scale(VAS) scores of low back and leg pain and Oswestry di
作者
陈焕雄
何小元
黄涛
马承榕
孟志斌
CHEN Huan-xiong;HE Xiao-yuan;HUANG Tao;MA Cheng-rong;MENG Zhi-bin(Department of Spinal Surgery,First Affiliated Hospital of Hainan Medical University,Haikou 570102,Hainan,China)
出处
《脊柱外科杂志》
2020年第3期145-150,157,共7页
Journal of Spinal Surgery
基金
国家自然科学基金青年科学基金项目(81902270)
海南省自然科学基金青年基金项目(819QN365)。
关键词
腰椎
椎间盘移位
椎管狭窄
脊柱融合术
外科手术
微创性
计算机辅助设计
成像
三维
Lumbar vertebrae
Intervertebral disc displacement
Spinal stenosis
Spinal fusion
Surgical procedures
minimally invasive
Computer-aided design
Imaging
three-dimensional
