术中三维CT导航辅助下微创经椎间孔腰椎椎体间融合术的可行性研究  

Clinical feasibility of minimally invasive transforaminal lumbar interbody fusion with intraoperative computed tomography-guided navigation system

作　　者：齐鹏[1] 毛克亚[1] 肖嵩华[1] 张西峰[1] 张永刚[1] 王征[1] 王岩[1] 崔赓[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《中国骨与关节杂志》2015年第11期880-886,共7页Chinese Journal of Bone and Joint

摘　　要：目的通过对比术中三维CT导航辅助下微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion with intraoperative computed tomography,i CT-MIS-TLIF)、单纯微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与传统开放经椎间孔腰椎椎体间融合术(conventional open transforaminal lumbar interbody fusion,COTLIF)治疗单节段腰椎退行性疾病的临床效果差异,探讨术中三维CT导航辅助下MIS-TLIF的可行性。方法 2009年4月至2011年9月,我院收治45例单节段腰椎间盘突出患者,根据患者自己的治疗意愿及术前资料的综合分析,11例采用i CT-MIS-TLIF进行治疗,15例采用MIS-TLIF进行治疗,19例采用COTLIF进行治疗。比较三组患者在手术时间、术中出血量、术后引流量、术后平均住院日和术后下床时间的差异,统计术前、术后3天、1.5个月、3个月、6个月、12个月、24个月Oswestry功能障碍指数(oswestry disability index,ODI),疼痛视觉模拟评分(visual analogue scale,VAS)和X线评价治疗效果。同时,考虑到术中三维CT导航对手术时间的影响,单独记录了术中三维CT导航扫描、注册等所需时间。结果术后平均随访24个月,三组患者术前一般资料、VAS和ODI评分差异无统计学意义。术后45例均未出现手术相关并发症。i CT-MIS-TLIF组手术时间显著高于MIS-TLIF组和COTLIF组,差异有统计学意义(P<0.05);i CT-MIS-TLIF组和MIS-TLIF组术中平均出血量、术后平均引流量、术后平均住院日、术后下床时间差异无统计学意义(P>0.05),且均明显低于COTLIF组(P<0.05)。三组VAS和ODI评分的随访结果与术前相比均有显著改善,但i CT-MIS-TLIF组和MIS-TLIF组术后3天腰痛VAS评分、术后1.5个月ODI评分显著低于COTLIF组,其余时间点三组之间评分差异无统计学意义,且i CT-MIS-TLIF和MIS-TLIF组间术后各时间点VAS和ODI评分差异无统计学意义。术后Objective To compare clinical outcomes of the minimally invasive transforaminal lumbar interbody fusion（ MIS-TLIF） with intraoperative computed tomography（ i CT） navigation system, minimally invasive transforaminal lumbar interbody fusion（ MIS-TLIF） and conventional open transforaminal lumbar interbody fusion（ COTLIF） for single-level lumbar fusion surgery, by which to evaluate clinical effects and feasibility of the MIS-TLIF by assistance of i CT navigation system. Methods From April, 2009 to September, 2011, 45 patients diagnosed as lumbar disc herniation（ LDH） were treated by one team of surgeons at a single institution. Minimally invasive transforaminal lumbar interbody fusion with intraoperative computed tomography（ i CT-MIS-TLIF） was conducted in 11 cases. MIS-TLIF was conducted in 15 cases. COTLIF was conducted in 19 cases. Patient＇s condition was considered and the treatment was voluntarily chosen by patients. Detailed procedures, preoperative and intraoperative images were illustrated. Operation time, intraoperative blood loss, postoperative blood loss（ drain）, mean hospital stay and postoperative ambulation period in 3 groups were compared. Oswestry disability index（ ODI）, visual analogue scale（ VAS） and X-ray 3 days, 1.5, 3, 6, 12, 24 months postoperatively were applied to evaluate clinical effects. Considering the influence of CT guidance on the operation time, the time cost in scanning and registration were recorded. Results The mean follow-up period was 24 months. There were no significant differences in routine clinical data, VAS and ODI. No complications occurred in all 45 patients. The operation time in i CT-MIS-TLIF group was significantly higher than MIS-TLIF group and COTLIF group（ P0.05）. No significant differences existed in mean operative blood loss, mean postoperative blood loss（ drain）, mean postoperative hospital stay and mean postoperative ambulation time（ P〈0.05） in i CT-MIS-TLIF group and MIS-TLIF group, which were significantly lowe

关 键 词：体层摄影术 X线计算机 外科手术 计算机辅助 腰椎 椎间盘移位 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]