中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (24): 3790-3795.doi: 10.12307/2021.081

• 数字化骨科 digital orthopedics • 上一篇    下一篇

计算机导航微创经椎间孔腰椎椎间融合治疗腰椎滑脱

钱选昆,黄合飞,武成聪,刘克廷,欧  华,张金鹏,任  静,万建杉   

  1. 曲靖市第一人民医院脊柱外科,云南省曲靖市   655000
  • 收稿日期:2020-09-25 修回日期:2020-09-28 接受日期:2020-11-09 出版日期:2021-08-28 发布日期:2021-03-05
  • 通讯作者: 任静,副主任医师,曲靖市第一人民医院脊柱外科,云南省曲靖市 655000 万建杉,主任医师,曲靖市第一人民医院脊柱外科,云南省曲靖市 655000
  • 作者简介:钱选昆,男,1989年生,汉族,2016年兰州大学毕业,硕士,主治医师,主要从事脊柱微创方面的研究。
  • 基金资助:
    云南省教育厅科学研究基金项目(2016ZDX074),项目负责人:武成聪

Computer-assisted navigation combined with minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis

Qian Xuankun, Huang Hefei, Wu Chengcong, Liu Keting, Ou Hua, Zhang Jinpeng, Ren Jing, Wan Jianshan   

  1. Department of Spine Surgery, No.1 People’s Hospital of Qujing, Qujing 655000, Yunnan Province, China
  • Received:2020-09-25 Revised:2020-09-28 Accepted:2020-11-09 Online:2021-08-28 Published:2021-03-05
  • Contact: Ren Jing, Associate chief physician, Department of Spine Surgery, No.1 People’s Hospital of Qujing, Qujing 655000, Yunnan Province, China Wan Jianshan, Chief physician, Department of Spine Surgery, No.1 People’s Hospital of Qujing, Qujing 655000, Yunnan Province, China
  • About author:Qian Xuankun, Master, Attending physician, Department of Spine Surgery, No.1 People’s Hospital of Qujing, Qujing 655000, Yunnan Province, China
  • Supported by:
    the Scientific Research Foundation Project of Yunnan Provincial Department of Education, No. 2016ZDX074 (to WCC) 

摘要:

文题释义:

MIS-TLIF:全称微创经椎间孔腰椎椎间融合术,是一种常用的椎间融合技术,在置入融合器时为避免牵拉和损伤硬膜囊和神经根,在椎体一侧打开椎间孔并植入融合器。MIS-TLIF是在原来开放手术基础上经椎间隙入路或通道下进行上述操作,对机体创伤小,术后恢复更快。
导航联合椎间盘镜通道:手术过程中通过计算机导航引导下进行精准置钉、减压,操作过程中在通道下到达椎体表面,结合椎间盘镜进行减压、融合等相关操作。

背景:目前已有研究报道计算机导航引导下脊柱手术与传统手术相比具有可视化、精准化等特点,此次试验进一步探索研究。
目的:对比计算机辅助导航联合锥形通道椎间盘镜下微创经椎间孔腰椎椎间融合与传统开放手术治疗腰椎滑脱的临床疗效,为临床选择治疗方案提供依据。
方法:回顾分析2014年3月至2018年3月曲靖市第一人民医院脊柱外科完成经椎间孔腰椎椎间融合治疗的腰椎滑脱症患者,其中30例采用导航联合锥形通道椎间盘镜通道下手术(微创组),与同期30例采用传统开放手术(开放组)的患者进行比较。收集两组手术时间、出血量、术后引流量、术后卧床时间、住院时间及并发症,随访患者腰腿痛目测类比评分和Oswestry功能障碍指数,通过影像学检查评估置钉准确率及植骨融合率,并进行统计分析比较。
结果与结论:①所有患者均获随访,随访时间12-40个月;②两组患者的性别、年龄、术前目测类比评分、Oswestry功能障碍指数、滑脱节段等基线资料相比差异无显著性意义(P > 0.05);③微创组手术时间略长于开放组,但差异无显著性意义(P > 0.05);出血量、术后引流量、卧床时间及住院时间微创组明显少于开放组,差异有显著性意义(P < 0.05);④两组患者术后Oswestry功能障碍指数及目测类比评分均较术前明显降低,且术后随访微创组Oswestry功能障碍指数、腰背痛目测类比评分小于开放组,差异有显著性意义(P < 0.05);⑤置钉准确率微创组高于开放组,差异有显著性意义(P < 0.05);⑥在随访期间所有患者术后复查未见明显内固定无松动、折断或异常活动等情况,末次随访两组植骨融合率差异无显著性意义;⑦提示与开放经椎间孔腰椎椎间融合相比,计算机导航联合锥形通道椎间盘镜辅助下微创经椎间孔腰椎椎间融合治疗腰椎滑脱具有出血量少、创伤小、下床时间早、术后恢复快、置钉准确率高等优点,是治疗腰椎滑脱的较好选择。
https://orcid.org/0000-0001-5105-8243 (钱选昆) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 计算机导航, 椎间盘镜, 腰椎滑脱, 微创, 经椎间孔腰椎椎体间融合

Abstract: BACKGROUND: At present, some studies have reported that navigation assisted spinal surgery has the characteristics of visualization and precision compared with traditional surgery, and this tail will further explore and study it.
OBJECTIVE: To compare the clinic effect between minimally invasive transforaminal lumbar interbody fusion with computer navigation and open transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis and provide evidence to choose a batter operative method. 
METHODS: A retrospective analysis of 60 patients with lumbar spondylolisthesis who were hospitalized at the Department of Spine Surgery, No.1 People’s Hospital of Qujing from March 2014 to March 2018 undergoing transforaminal lumbar interbody fusion was conducted. Of them, 30 cases were treated with navigation and microendoscopic discectomy (minimally invasive group); other 30 cases underwent open-transforaminal lumbar interbody fusion and pedicle screw fixation (open group). Operation time, blood loss, postoperative drainage volume, postoperative bedridden time, hospitalization time, and complications were collected in both groups. Visual analogue scale scores and Oswestry disability index were followed up. Accuracy of pedicle screw insertion and bone graft fusion rate were assessed using imaging examination between the two groups. Above indexes were statistically analyzed and compared between the two groups.  
RESULTS AND CONCLUSION: (1) All patients were followed up from 12 to 40 months. (2) There were no significant differences between two groups in age, sex, preoperative visual analogue scale, Oswestry disability index, and level of spondylolysis (P > 0.05). (3) The operation time was slightly longer in the minimally invasive group than in the open group, but there was no significant difference in operation time between the two groups (P > 0.05). The blood loss, the postoperative drainage volume, bedridden time and hospitalization time of minimally invasive group were significantly less than those of open group (P < 0.05). (4) Oswestry disability index and back pain visual analogue scale scores were significantly decreased after treatment in both groups; moreover, visual analogue scale scores and Oswestry disability index of minimally invasive group were lower than that of open group after operation (P < 0.05). (5) The accuracy of pedicle screw insertion of minimally invasive group was superior to that of open group (P < 0.05). (6) No obvious internal fixation loosening, broken, or abnormal activities were found in all patients during the follow-up. There was no significant difference in the bone graft fusion rate between the two groups at the last follow-up. (7) It is indicated that compared with the open transforaminal lumbar interbody fusion, computer-assisted navigation combined with microendoscopic discectomy channel minimally invasive transforaminal lumbar interbody fusion treatment for lumbar spondylolisthesis has advantages of less blood loss, less trauma, less bedridden time, rapid recovery, higher accuracy of pedicle screw insertion, which is a good selection for lumbar fusion. 

Key words: computer navigation, intervertebral disc endoscope, lumbar spondylolisthesis, minimally invasive, transforaminal lumbar interbody fusion

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