| 高放,方忠,刘广武,等.导航辅助经皮置钉微创经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的疗效研究.骨科,2018,9(4): 260-267. |
| 导航辅助经皮置钉微创经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的疗效研究 |
| Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion aided with computer navigation for degenerative lumbar disease |
| 投稿时间：2017-11-14 |
| DOI：10.3969/j.issn.1674-8573.2018.04.002 |
| 中文关键词: 腰椎 椎间盘退行性变 外科手术，计算机辅助 外科手术，微创性 脊柱融合术 |
| 英文关键词: Lumbar vertebrae Intervertebral disc degeneration Surgery, computer-assisted Surgical procedures, minimally invasive Spinal fusion |
| 基金项目:国家重点研发计划（2016YFB1101300）；中央高校基本科研业务费专项资金（2014TS074）；湖北省自然科学基金（2014CFB196） |
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| 中文摘要: |
| 目的 评估导航辅助经皮置钉微创经椎间孔腰椎椎间融合术（minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF）治疗腰椎退行性疾病的临床疗效。方法 回顾性分析2013年1月至2015年2月，我科收治的腰椎退行性疾病病人60例，其中行导航辅助MIS-TLIF手术病人26例（导航辅助MIS-TLIF组），行开放TLIF手术34例（开放TLIF组）。收集两组病人的手术时间、术中出血量、术后引流量及并发症等情况；记录病人手术前后不同时间的腰痛、下肢痛疼痛视觉模拟量表（visual analogue scale, VAS）评分和Oswestry功能障碍指数（Oswestry disability index, ODI）；通过其腰椎X线、CT、MRI检查结果，评估椎间融合率、置钉精准率等影像学指标。结果 病人随访时间为24~36个月，所有病人均未出现神经、血管损伤等严重永久性并发症。导航辅助MIS-TLIF组的手术时间为（146.8±20.9） min，显著长于开放TLIF组的（133.6±15.8） min，其术中出血量、术后引流量、术后住院天数分别为（172.4±71.2） ml、（130.0±40.6） ml、（5.8±2.2） d，显著低于开放TLIF组的（253.3±88.6） ml、（206.1±38.8） ml、（7.5±1.9） d，上述指标组间比较，差异均具有统计学意义（P均＜0.05）。导航辅助MIS-TLIF组术后2 d腰痛VAS评分为（3.1±1.6）分，显著低于开放TLIF组的（4.4±1.1）分，差异具有统计学意义（t=3.837，P＜0.001）；但两组病人术后3、6、12、24个月的腰痛VAS评分、下肢痛VAS评分及腰痛ODI比较，差异均无统计学意义（P均＞0.05）。导航辅助MIS-TLIF组和开放TLIF组的椎间融合率分别为80.77%、82.35%，置钉精准率分别为90.38%、88.97%，组间比较，差异均无统计学意义（P均＞0.05）。结论 导航辅助MIS-TLIF术治疗腰椎退行性疾病临床疗效良好，置钉精准、安全性高，并且更加微创、出血少、术后腰痛轻微、康复快。 |
| 英文摘要: |
| Objective To assess the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) aided with computer navigation for degenerative lumbar disease. Methods Total of 60 patients with degenerative lumbar disease were enrolled in our retrospective study during January 2013 and February 2015: 26 patients were treated with MIS-TLIF aided with computer navigation (MIS-TLIF group) and 34 patients were treated with open transforaminal lumbar interbody fusion (open-TLIF group). Operation time, blood loss, postoperative drainage, postoperative hospital stay and complications were all recorded. Visual analog scale (VAS) for low back pain and leg pain and Oswestry disability index (ODI) for low back pain were used to evaluate the clinical efficacy of surgery. Three-dimensional CT was used to assess the fusion rate and accuracy of pedicle screw placement. Results All patients were followed up for 24-36 months, and no serious permanent complications, such as nerve or vascular injury, were found in all patients. The mean operation time was significantly shorter [(133.6±15.8) min vs. (146.8±20.9) min], the mean blood loss and postoperative drainage were significantly less [(172.4±71.2) ml vs. (253.3±88.6) ml, and (130.0±40.6) ml vs. (206.1±38.8) ml], and postoperative stay was significantly shorter [(5.8±2.2) days vs. (7.5±1.9) days] in MIS-TLIF group than in open-TLIF group (P＜0.05 for all). VAS for low back pain at 2nd day postoperation was significantly lower in MIS-TLIF group than in open-TLIF group (t=3.837, P＜0.001). VAS for leg pain, VAS for low back pain, and ODI at 3rd, 6th, 12th, and 24th mouth postoperation showed no significant difference between two groups. Fusion rate showed no significant difference between two groups (80.7% in MIS-TLIF group vs. 82.4% in open-TLIF group). There was no significant difference in accuracy of pedicle screw placement between two groups (90.38% in MIS-TLIF group vs. 88.97% in open-TLIF group). Conclusion MIS-TLIF aided with computer navigation has good clinical efficacy on degenerative lumbar disease. It has advantages such as milder trauma, less blood loss, milder postoperative low back pain, more precise pedicle screw placement. |
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