CT导航下MIS-TLIF手术在腰椎间盘突出症的临床应用

Clinical application of CT guided MIS-T LIF surgery in lum bar disc herniation

目的探讨微创经椎间孔入路椎间植骨融合术(MIS-TLIF)治疗腰椎间盘突出症过程中,采用三维CT导航的临床应用效果。方法回顾性分析2014-07-2015-08行MIS-TLIF手术治疗的61例LDH患者,其中采用三维CT导航下手术28例(研究组),C臂机X线透视导航33例(对照组),对比两组患者的相关指标。结果 (1)围手术期指标:与对照组相比,研究组的透视次数明显减少,且置钉效果为优的比例更高(均为P<0.05);但研究组手术时间更长,术中出血量更多(均为P<0.05)。(2)两组患者均获随访2年以上,术后3 d、3个月和末次随访时,其腰腿痛VAS评分均显著改善(P<0.05),但组间对比未见统计学差异(P>0.05);术后3个月和末次随访时,两组ODI指数均较术前显著改善(P<0.05),但组间亦无统计学差异(P>0.05)。(3)末次随访时,两组患者椎间植骨均完全融合,组间无显著性差异(P>0.05)。结论在MIS-TLIF手术应用中,与传统X线透视相比,CT导航显著减少了透视次数,提高了置钉效果,但手术时间明显延长、增加了出血量。因此,针对不同患者,应酌情选用合适的影像学导航技术。

Objective To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） in the treatment of lumbar disc herniation （LDH） by three - dimensional CT navigation. Methods From July 2014 to August 2015,the clinical data of 61 patients with LDH who received MIS-TLIF surgical treatment were retrospectively analyzed. Twenty -eight patients in study group used 3D CT navigation. Thirty-three patients in control group received C arm fluoroscopy based navigation. The relevant indicators were compared between the two groups. Results（1） Perioperative indicators： compared with the control group, the perspective times of study group significantly reduced, and the proportion of excellent placement results was higher （P〈0.05）. But the study group had longer operative time and more intraoperative blood loss compared with control group （P〈0.05）. （2） All patients were followed up for more than 2 years. At 3 d, 3 months after operation and at the end of the follow-up, the VAS scores were significantly improved （P〈0.05）, but there was no significant difference between the two groups （P〉0.05）. Three months after operation and at the last follow-up, the ODI index of two groups were significantly improved compared with before operation（!〈 0.05）, but there was no statistically significant difference between the two groups （P〉0.05）. （3） At thelast follow-up, interbody fusion was complete in the two groups, and there was no significant difference between the two groups （P〉0.05）. Conclusion Compared with traditional fluoroscopy in MIS-TLIFthe amount of bleeding is increased. Therefore,surgery, CT navigation significantly reduces the fluoroscopy times and improves the effect of nailing, but the operation time is prolonged andappropriate imaging navigation techniques should be selected for different patients.