术中三维CT导航下微创治疗单节段腰椎退行性疾病的疗效评价

Clinical effects of one- level posterior lumbar interbody fusion: minimally invasive irocedure with intraoperative computed tomography-guided navigation versus conventional open approach

[目的]对比在术中三维CT导航下微创经椎间孔腰椎椎体间融合术（minimally invasive transforaminal lumbar interbody fusion）（i CT-MITLIF）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,评价术中三维CT导航下微创手术治疗单节段腰椎退行性疾病的安全性和有效性。[方法]2009年4月～2011年9月,30例连续单侧、单节段腰椎间盘突出伴有腰椎间盘源性腰痛患者,根据患者自己的治疗意愿,11例采用术中三维CT导航下微创经椎间孔腰椎椎体间融合术（i CTMITLIF）进行治疗,19例采用传统开放经椎间孔腰椎椎体间融合术（COTLIF）进行治疗。比较两组患者在手术时间、术中医生和患者放射线的暴露剂量、术中出血量、术后引流量、术后下地时间和术后平均住院日,并采用Oswestry Disability Index（ODI）,Visual Analogue scores（VAS）和X线评价治疗效果。[结果]i CT-MITLIF组手术时间、患者放射线的暴露剂量均显著高于COTLIF组（P〈0.05）;而i CT-MITLIF组术中平均出血量、术后平均引流量、术后下地时间、术后平均住院日均明显低于COTLIF组（P〈0.05）。术后3 d MITLIF组腰痛VAS评分及术后1.5个月MITLIF组ODI评分显著低于COTLIF组（P〈0.05）。术后X线评价融合率两组亦无显著性差异。[结论]术中三维CT导航下MITLIF治疗单节段腰椎退行性疾病,可以获得安全、有效的治疗结果。

[Objective] This study aimed to compare the clinical outcomes of the minimally invasive transforaminal lumbar interbody fusion（ MITLIF） with intraoperative computed tomography（ i CT） navigation system versus conventional open transforaminal lumbar interbody fusion（ COTLIF） for single- level lumbar fusion surgery. [Methods] From Apr 2009 to Sep 2011,30 consecutive patients diagnosed as lumbar disc herniation（ LDH） and discogenic low back pain（ DLBP） were treated by one team of surgeons at a single institution,including 11 received minimally invasive transforaminal lumbar interbody fusion（ MITLIF） and 19 received conventional open transforaminal lumbar interbody fusion（ COTLIF）（ voluntarily chosen by patients）.All patients were followed up for 24 months. The detailed procedures,preoperative,and intraoperative images were illustrated. The operation time,intraoperative blood loss,postoperative blood loss（ drain）,preoperative and postoperative pain scale of low back and leg pain Visual Analogue scores（ VAS）,complications,postoperative ambulation time,postoperative hospital stay and X- ray examination from each group were evaluated before surgery,after surgery and in the follow- up period. [Results] There were significant differences between two groups in mean operative time,mean operative blood loss,mean postoperative blood loss,mean postoperative ambulation time and mean postoperative hospital stay. Mean VAS scores of low back pain at postoperative 3thday and ODI scores at postoperative 1. 5thmonth were significantly different. There were significant differences considering the mean VAS scores of postoperative leg pain during follow- up,mean VAS scores of low back pain at postoperative 6th,12 thand 24thmonth as well as lumbar fusion rate between two groups. [Conclusion] Patients received MITLIF with i CT navigation system have similar good long- term clinical outcomes and high fusion rates as those received conventional open transforaminal lumbar interbody fusion（ COTLIF）,and MITLIF with i CT Navigation System provides the additional benefits of less early postoperative back pain,less functional disability,early rehabilitation and shorter hospitalization.