电磁导航辅助经皮内镜下腰椎间融合术治疗单节段腰椎滑脱症疗效观察  

Electromagnetic navigation-assisted percutaneous endoscopic transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis

作　　者：吴非燃 李俊青 王辉 姚杰 朱卉敏 WUFeiran;LI Junqing;WANG Hui;YAO Jie;ZHU Huimin(Department of Spinal Minimally Invasive Surgery,Luoyang Orthopedic Hospital of Henan,Henan Orthopedic Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省洛阳正骨医院、河南省骨科医院脊柱微创中心,河南郑州450000

出　　处：《中华实用诊断与治疗杂志》2025年第3期244-248,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220252)。

摘　　要：目的 比较电磁导航辅助经皮内镜下经椎间孔腰椎椎体间融合术(Endo-TLIF)与微创经椎间孔腰椎椎体间融合术(MIS-TLIF)治疗单节段腰椎滑脱症的疗效,探讨其安全性。方法 2022年1月—2023年7月河南省骨科医院诊治单节段腰椎滑脱症患者72例,35例行电磁导航辅助Endo-TLIF者为导航组,37例行MIS-TLIF者为常规组。记录2组术中置钉数、术中透视次数、手术时间、术中出血量、术后引流量及住院期间神经损伤、血管损伤、螺钉松动、移位等置钉相关并发症发生情况;术后第2天行腰椎64排CT扫描,采用Gertzbein-Robbins分级评估置钉准确率;术前、术后3 d及术后6个月采用视觉模拟评分(VAS)评估腰背痛及下肢疼痛程度,采用Oswestry功能障碍指数(ODI)评分评估腰椎功能。结果 导航组置入螺钉140枚,常规组置入148枚,导航组置钉准确率(94.29%)高于常规组(85.81%)(χ^(2)=5.706,P=0.017)。2组住院期间均无置钉相关并发症发生。导航组术中透视次数[(16.60±2.99)次]、术中出血量[(139.42±22.09)mL]、术后引流量[(114.86±19.76)mL]均少于常规组[(31.78±4.89)次、(233.51±25.63)mL、(219.73±32.87)mL](t=-16.508~-15.990,P均<0.001),手术时间与常规组比较差异无统计学意义(P>0.05)。导航组术后3 d VAS[(2.03±0.86)分]、ODI评分[(27.20±6.30)分]均低于常规组[(2.51±0.80)、(45.30±8.03)分](t=-2.478,P=0.016;t=-10.592,P<0.001),术前及术后6个月VAS、ODI评分与常规组比较差异均无统计学意义(P>0.05)。结论 单节段腰椎滑脱症患者行电磁导航辅助Endo-TLIF与MIS-TLIF具有相同的中期疗效和安全性,但采用电磁导航辅助Endo-TLIF可提高置钉准确率,减少术中辐射暴露、术中出血量和术后引流量。Objective To compare the efficacy of electromagnetic navigation-assisted percutaneous endoscopic transforaminal lumbar interbody fusion(Endo-TLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on single-segment lumbar spondylolisthesis,and to explore their safety.Methods Seventy-two patients with single-segment lumbar spondylolisthesis were diagnosed and treated in Henan Orthopedic Hospital from January 2022 to July 2023,among whom 35 patients received electromagnetic navigation-assisted Endo-TLIF(the navigation group)and 37 patients received MIS-TLIF(the conventional group).The number of intraoperative screw placement,intraoperative fluoroscopy frequency,operative time,intraoperative blood loss,postoperative drainage volume,and the occurrence of complications such as nerve injury,vascular injury,and screw loosening and translocation during hospitalization were recorded in two groups.The 64-slice CT scan of lumbar spine was performed,and the screw placement accuracy was evaluated by Gertzbein-Robbins classification on the second day postoperatively.The degree of low back pain and lower limb pain was assessed using Visual Analogue Scale(VAS)and the lumbar function was assessed using Oswestry Disability Index(ODI)score before operation,3 d after operation,and 6 months after operation.Results A total of 140 screws were placed in the navigation group and 148 screws in the conventional group.The screw placement accuracy was higher in the navigation group(94.29%)than that in the conventional group(85.81%)(χ^(2)=5.706,P=0.017).No complications related to screw placement occurred during hospitalization in both groups.The navigation group demonstrated significantly lower values compared to the conventional group in the following parameters:intraoperative fluoroscopy frequency(16.60±2.99 vs.31.78±4.89),intraoperative blood loss[(139.42±22.09)mL vs.(233.51±25.63)mL],and postoperative drainage volume[(114.86±19.76)mL vs.(219.73±32.87)mL](t=-16.508 to-15.990,all P values<0.001).No statistically

关 键 词：腰椎滑脱症 单节段 电磁导航 内镜下经椎间孔腰椎椎体间融合术 微创经椎间孔腰椎椎体间融合术 

分 类 号：R687.3[医药卫生—骨科学]