“O”型臂导航辅助MIS-TLIF与开放TLIF治疗低度腰椎滑脱的早期疗效比较  

Early clinical and radiological outcomes of O-arm navigated MIS-TLIF versus open TLIF in treating lumbar spondylolisthesis

作　　者：杨宇豪 周庆双 陈豪杰 孙凯[2] 王斌[2] 朱泽章[2] 邱勇[2] 孙旭[1] Yang Yuhao;Zhou Qingshuang;Chen Haojie;Sun Kai;Wang Bin;Zhu Zezhang;Qiu Yong;Sun Xu(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University;Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University)

机构地区：[1]南京医科大学鼓楼临床医学院骨科脊柱外科,南京210008 [2]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008

出　　处：《中华骨科杂志》2024年第17期1133-1142,共10页Chinese Journal of Orthopaedics

基　　金：江苏省医学创新中心(CXZX202214);2023年度南京鼓楼医院医疗新技术发展专项资金资助(XJSF-ZLX202303)。

摘　　要：目的为比较“O”型臂导航辅助微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)和开放TLIF治疗腰椎滑脱的早期临床疗效。方法回顾性分析2018年5月至2023年7月于南京大学医学院附属鼓楼医院骨科脊柱外科接受“O”型臂导航辅助MIS-TLIF(MIS-TLIF组)与开放TLIF(开放TLIF组)手术治疗的单节段低度腰椎滑脱患者。MIS-TLIF组60例,男24例、女36例,年龄(41.0+13.9)岁(范围18~73岁);开放TLIF组120例,男43例、女77例,年龄(41.6+12.6)岁(范围18~69岁)。比较两组患者术前腰椎CT及MRI评估的滑脱头侧节段关节突关节退变分级与椎旁肌脂肪浸润情况、术前与术后侧位X线片腰椎滑脱参数、术后腰椎CT评估置钉不良事件及头侧关节突关节损伤程度,以及术前、术后3个月的Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟评分(visual an-alogue scale,VAS)。结果两组患者基线信息、关节突关节退变等级、椎旁肌脂肪浸润及术前ODI、VAS评分的差异均无统计学意义(P>0.05)。MIS-TLIF组手术时间为(223.3±23.0)min,长于开放TLIF组的(187.0±30.5)min,差异有统计学意义(t=8.130,P<0.001);MIS-TLIF组手术出血量[(150.7±56.8)ml]、术后引流量[(60.4±19.8)ml]和术后住院时间[(4.5±1.7)d]少于开放TLIF组[分别为(392.8±161.5)ml、(215.2±57.2)ml、(8.4±2.5)d],差异均有统计学意义(t=-11.253,P<0.001;t=-20.328,P<0.001;t=-10.769,P<0.001)。MIS-TLIF组术后3个月VAS腰痛评分低于开放TLIF组(分别为2.0±1.7和3.2±2.0,t=-3.956,P<0.001)。两组患者术后滑脱参数间差异无统计学意义(P>0.05)。MIS-TLIF组置钉准确性(98.8%)和关节突关节损伤情况(27.5%)优于开放TLIF组(分别为92.3%和51.7%,P<0.001)。两组均未发生危险置钉事件。MIS-TLIF组术后1例出现切口内肌层下血肿;开放TLIF组3例出现术中硬脊膜撕裂、1例一过性L,神经根麻痹及1例早期伤口浅表感染。结论“O”型�Objective To compare the early clinical outcomes,screw placement accuracy and supradjacent facet joint vi-olation between O-arm navigated minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and TLIF for the treat-ment of lumbar spondylolisthesis.Methods We retrospectively reviewed a cohort of low-grade single level lumbar spondylolis-thesis patients who have received O-arm navigated MIS-TLIF or open-TLIF treatment from May 2018 to July 2023.There were 60 patients in MIS-TLIF group including 24 males and 36 females,and the average age was 41.0±13.9 years(18-73 years).There were 120 patients in open-TLIF group including 43 males and 77 females,and the average age was 41.6±12.6 years(18-69 years).The demographic and perioperative data of patients were recorded.Preoperative lumbar CT and MRI were evaluated to assess the grade of adjacent facet joint degeneration and fatty infiltration in the lumbar paraspinal muscles.The slip parameters were mea-sured by lateral X-ray films before and after operation,and the screw placement accuracy and supradjacent facet joint violation were evaluated by postoperative CT.Patient reported outcomes,including Oswestry disability index(ODI)and visual analogue scale(VAS)were collected preoperatively and 3 months postoperatively.Results There was no significant difference in demographic data,adjacent facet joint degeneration,fatty infiltration of lumbar paraspinal muscles and preoperative ODI and VAS scores between the two groups(P>0.05).The operation time in MIS-TLIF group(223.3±23.0 min)was significantly longer than that in open-TLIF group(187.0±30.5 min,t=8.130,P<0.001),while the intraoperative blood loss(150.7±56.8 ml s.392.8±161.5 ml,t=-11.253,P<0.001),postoperative drainage(60.4±19.8 ml us.215.2±57.2 ml,t=-20.328,P<0.001)and postoperative hospital stay(4.5±1.7 d vs.8.4±2.5 d,t=-10.769,P<0.001)in MIS-TLIF group were significantly less.The 3-month postoperative VAS back pain of the MIS-TLIF group(2.0±1.7)was lower than the open-TLIF group(3.2±2.0,t=-3.956,P<

关 键 词：手术导航系统 脊柱融合术 脊椎滑脱 椎弓根钉 椎关节突关节 

分 类 号：R687.3[医药卫生—骨科学]