出 处:《中国脊柱脊髓杂志》2021年第8期712-718,共7页Chinese Journal of Spine and Spinal Cord
基 金:广州市科技计划项目(项目编号:202103000053)。
摘 要:目的:对比分析O型臂X线机与C型臂X线机引导经皮置钉在双通道内镜下经椎间孔减压椎间融合术(unilateral biportal endoscopic transforaminal lumbar interbody fusion,UBE-TLIF)中的应用。方法:回顾性分析2020年1月1日~2020年9月30日于我院接受UBE-TLIF治疗的腰椎退行性疾病患者50例。其中男性25例,女性25例,年龄23~80岁(58.9±12.8岁)。根据术中经皮椎弓根螺钉置钉导航设备的不同分为O臂组(27例)和C臂组(23例)。O臂组男性17例,女性10例,年龄23~80岁(58.8±14.3岁);C臂组男性8例,女性15例,年龄27~76岁(59.0±10.9岁)。比较两组手术时间、术中出血量、术后住院天数,术后1周内通过GertzbeinRobbins(G-R)分级评估置钉准确性;术前及术后3个月进行Oswestry功能障碍指数(Oswestry disability index,ODI)评定、腰部及下肢疼痛视觉模拟(visual analog scale,VAS)评分,术后3个月通过改良Macnab疗效指标评估临床疗效。统计并比较两组手术并发症、翻修率情况。结果:O臂组手术时间为196.0±37.5min,C臂组为260.9±69.4min,差异有统计学意义(P<0.05)。O臂组出血量为108.1±149.6ml,C臂组为106.5±108.0ml;O臂组术后住院天数为5.3±1.7d,C臂组为5.2±1.6d,差异均无统计学意义(P>0.05);术后1周O臂组置钉GertzbeinRobbins(G-R)分级优于C臂组(P<0.05)。两组术后3个月VAS、ODI评分均较术前显著改善(P<0.05)。O臂组与C臂组Macnab疗效指标优良率分别为93%和91%,差异无统计学意义(P>0.05)。O臂组手术并发症发生率为7.4%(2/27)与C臂组为8.7%(2/23),两组间差异无统计学意义(P>0.05),经保守治疗后患者康复出院。两组均无翻修病例。结论:与C型臂X线机相比,O型臂X线机引导可以提高UBE-TLIF经皮置钉的精确性、缩短手术时间,具有良好的辅助置钉作用。Objectives:To compare and analyze the application of O-arm and C-arm guided percutaneous screw placement in unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF).Methods:A retrospective analysis was made on 50 patients with lumbar degenerative disease treated by UBE-TLIF from January 1,2020 to September 30,2020 in our hospital,including 25 males and 25 females,averaged age was 58.9±12.8 years(23-80 years old).The patients were divided into O-arm group(27 cases)and C-arm group(23 cases)according to the technique of Percutaneous pedicle screw placement.The O-arm group consisted of 17 males and 10 females,averaged age was 58.8±14.3 years(23-80 years old),while the C-arm group consisted of 8 males and 15 females,averaged age was 59.0±10.9 years(27-76 years old).The operation time,intraoperative bleeding,postoperative hospital stay,and the accuracy of screw placement[GertzbeinRobbins(G-R)grading was used to evaluate the accuracy of screw placement 1 week after surgery]were compared between the two groups.The preoperative and 3-month post-operative Oswestry disability index(ODI)and visual analogue scale(VAS)for back and leg pain were evaluated,and 3-month post-operative modified Macnab criteria(Macnab)were used to evaluate the clinical efficacy.Surgical complications and revision rate were compared between the two groups.Results:The average operation time of O-arm group and C-arm group was 196.0±37.5 min and 260.9±69.4 min,respectively,the difference was statistically significant(P<0.05).The mean bleeding volume was 108.1±149.6 ml and 106.5±108.0 ml,and the average length of postoperative hospital stays were 5.3±1.7 days and 5.2±1.6 days,respectively.There was no significant difference between the two groups in the mean bleeding volume and the mean length of postoperative hospital stays(P>0.05).Gertzbein Robbins(G-R)grading of the O-arm group was better than that of the C-arm group(P<0.05).The VAS and ODI scores of both groups were significantly improved 3 months after operation compa
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