O-arm导航系统辅助下极外侧椎间融合联合椎弓根螺钉固定术的早期疗效和安全性评价

Early effect and safety evaluation of extreme lateral interbody fusion combined assisted by pedicle screw fixation with O-arm navigation system

目的:探讨O-arm导航系统引导下极外侧椎间融合(extreme lareral ineterbody fusion,XLIF)联合椎弓根螺钉固定术治疗腰椎退变性疾病的早期疗效及安全性。方法:回顾性分析26例行XLIF联合椎弓根螺钉固定术患者的病例资料。记录手术时间、术中出血量、并发症情况。通过X线片及CT扫描评价手术前后椎间高度、椎间孔面积、盘黄间隙及置钉准确情况。比较术前和末次随访时腰部疼痛视觉模拟评分(visual analogue scale,VAS)及功能障碍指数(oswestry disability index,ODI)。记录并对比融合器及螺钉置入前后运动、体感诱发电位与自发、诱发肌电图变化。结果:本组病例平均手术时间为(162.7±21.5)min,平均出血量为(117±34.9)mL。术后有3例患者出现手术切口侧髋关节屈曲乏力合并大腿前方麻木,经观察2周后症状均消失。所有患者均联合后路椎弓根螺钉固定术,共置入螺钉94枚,术后通过CT图像评价螺钉位置,其中I级螺钉:89枚(94.6%),II级螺钉5枚(5.4%)。术后CT测量影像学指标:术前椎间高度(4.09±1.45)mm,椎间孔面积(90.52±15.08)mm^2,盘黄间隙(2.44±0.60)mm;术后椎间高度(8.17±2.53)mm,椎间孔面积(128.22±17.16)mm^2,盘黄间隙(4.72±0.54)mm,术前术后数据比较,差异有统计学意义(P<0.05)。术后平均随访时间为25.6个月。末次随访时腰痛VAS评分由术前的(7.09±0.78)分降低至(2.11±0.71)分,ODI由术前的(51.27±11.63)%降低至(11.01±3.03)%,差异均有统计学意义(P<0.05)。融合器及螺钉置入前后运动、体感诱发电位的潜伏期和波幅无明显变化,无异常自发、诱发肌电图波形出现。结论:O-arm导航系统引导下XLIF联合椎弓根螺钉固定术治疗腰椎退变性疾病的影像学改善满意,置钉准确性高,早期疗效较好。

Objective:To explore the early efficacy and safety of extreme lateral invertebral fusion (XLIF) combined with pedicle screw fixation guided by O-arm navigation system in the treatment of lumbar degenerative diseases.Methods:A retrospective analysis was made of 26 patients who underwent XLIF combined with pedicle screw fixation.The operation time,blood loss and complications were recorded.X-ray and CT scans were used to evaluate the accuracy of the disc height,foraminalarea,disk-flavum ligamentum space,and screw placement accuracy before and after surgery.The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were compared before and at the final follow-up.Recorded and compared movements before and after the fusion device and screw placement,somatosensory evoked potentials and spontaneous,induced EMG changes.Results:The average time of operation in this group was (162.7±21.5)min,and the average blood loss was (117±34.9)mL.3 patients had postoperative incision lateral hip flexion fatigue combined with numbness in front of the thigh.After 2 weeks of observation,the symptoms disappeared.All patients were combined with posterior pedicle screw fixation.A total of 94 screws were placed.The position of the screws was evaluated by CT images after operation.Among them,Grade I screws 89 (94.6%),Grade II screws 5(5.4%).Imaging parameters measured by postoperative CT:disc height was (4.09±1.45)mm before operation,foraminal area was (90.52±15.08)mm^2,the disk-flavum ligamentum space was (2.44±0.60)mm,the postoperative disc height was (8.17±2.53)mm,and postoperative foraminal area was (128.22±17.16)mm^2,the postoperative disk-flavum ligamentum space was (4.72±0.54)mm,and the difference was statistically significant ( P <0.05).The average follow-up time was 25.6 months.At the final follow-up,the VAS score of low back pain decreased from preoperative (7.09±0.78) points to (2.11±0.71) points ( P <0.05).The difference was statistically significant.ODI decreased from preoperative (51.27±11.63)% to (11.01±3.03)%,the difference was statistically significant ( P <0.05).There was no significant change in the latency and amplitude of somatosensory evoked potentials before and after the insertion of the cage and screw,and there was no abnormal spontaneous electromyogram and induced EMG waveform.Conclusion:O-arm navigation system guided the extreme lateral interbody fusion with pedicle screw fixation for satisfactory radiographic improvement of degenerative lumbar disease.The accuracy of nail placement is high and the early effect is good.