导航微创与传统切开经椎间孔入路椎间植骨融合术治疗成人腰椎滑脱症的对照研究  

Navigation-assisted minimally invasive transforaminal lumbar interbody fusion versus traditional flu- oroscopy-assisted open transforaminal lumbar interbody fusion for adult lumbar spondylolisthesis -- arandomized controlled trial

作　　者：刘亚军[1] 田伟[1] 靳培浩[2] 吕艳伟[3] 孙玉珍[1] 张静[1] 

机构地区：[1]北京积水潭医院脊柱外科,100035 [2]清华大学医学中心,100035 [3]北京市创伤骨科研究所临床统计与流行病学研究室,100035

出　　处：《中华创伤骨科杂志》2014年第3期194-198,共5页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科技汁划项¨（D101100049910003）;北京市优秀人才培养资助项目（2009D003002000003）

摘　　要：目的比较研究导航微创经椎问孔入路椎问植骨融合木（TLIF）与传统切开TLIF治疗腰椎滑脱症的临床疗效。方法前瞻性地将2011年5月至2013年3月收治的符合纳入和排除标准的成人腰椎滑脱症患者分为2组，分别接受导航微创TLIF（导航微创组，13例）与传统切升TLIF（传统切开纰，14例）治疗，两组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有町比性。比较两组患者的手术时问、小m量、住院时间及术后日本骨科协会（JOA）改善率、Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）、Odom标准优良率、置钉优良率、滑脱率、复位率及融合率。结果所有患并均获随访，导航微创组和传统切开组平均随访时间分别为12．4个月和11．5个月。与传统切开组比较，导航微创组的出血量少、JOA改善率和ODI评分低，差异均有统计学意义（P〈0．05）。手术时问、住院时问、VAS评分、Odom标准优良率、置钉优良率、滑脱率、复位率及融合率两组问比较差异均无统计学意义（P〉0．05）。，结论与传统切开TLIF相比，导航微创TLIF具有手术出血少、肌肉剥离少、手术创伤小、置入螺钉位置精确等优点，具有良好的临床应用前景。Objective To compare the clinical outcomes of navigation-assisted minimally invasive transfuraminal lumbar interbody fusion （TLIF） with traditional fluoroseopy-assisted open TL1F. Methods Between May 2011 and March 2013, 27 eligible adult patients with lumbar spondylolisthesis were randomly assigned to receive navigation-assisted minimally invasive TLIF （13 cases） or traditional fluornscopy-assisted open TLIF （14 cases） . The 2 grnups were compatible with no significant differences in preoperative general data （ P 〉 O. 05）. The 2 groups were compared in terms of operation time, intraoperative blood loss, hospital stay, post-operative Japanese Orthopaedic Association （JOA）score, Oswestry disability Index （ODI）score, visual analogue scale （VAS） score, Odum＇ s evaluation, and rates of good to excellent pedicle insertion, olisthe, reduetiun and fusion. Results The navigation-assisted TLIF and traditional TLIF groups were followed up respectively for 12.4 and 11.5 months on average. The navigation-assisted minimally invasive TLIF group had significantly less blood loss, greater JOA improvement and lower ODI scores than the tradi- tional open TI,IF group （ P 〈 0. 05） . There were no significant differences between the 2 gruups regarding operation time, hospital stay, VAS score, Odom＇s evaluation, or rates of good to excellent pedicle insertion, olisthe, reduction and fusion （ P 〉 O. 05 ） . Conclusion Since navigation-assisted minimally invasive TLIF has advantages of decreased intraoperative blood loss, minimal invasion and accurate pediele insertion compared with traditional open TLIF, it has a promising prospect of clinical application.

关 键 词：腰椎 外科手术 计算机辅助 外科手术 微创性 椎弓峡部裂 

分 类 号：R687.3[医药卫生—骨科学]