红外线主动诱导计算机辅助三维导航系统与普通C型臂X线机透视辅助经皮微创手术治疗Kümmell病的比较研究

Comparison of Iso-C 3D navigation system versus X-ray fluoroscopy in minimally invasive surgery for Kümmell disease

目的比较红外线主动诱导计算机辅助三维导航系统(Iso-C三维导航系统)与普通C型臂X线机透视辅助经皮椎体后凸成形术(PKP)/经皮椎体成形术(PVP)治疗Kümmell病的临床效果。方法回顾性分析西安交通大学附属红会医院脊柱外科自2016年10月至2018年6月收治的Kümmell病患者资料。按照严格的纳入与排除标准最终纳入共42例患者,男11例,女31例;年龄43~72岁,平均57.4岁。根据手术辅助系统的不同分为2组:21例患者纳入观察组,应用Iso-C三维导航系统辅助PKP/PVP治疗;另21例患者纳入对照组,采用普通C型臂X线机透视辅助PKP/PVP治疗。比较观察组与对照组术前、术后1 d和术后6个月的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、cobb角以及椎体前缘高度。结果观察组与对照组Kümmell病患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。42例患者术后获6.0~18.5个月(平均9.6个月)随访。术后1 d观察组与对照组Kümmell病患者VAS评分分别为(2.2±0.7)、(3.9±1.5)分,ODI指数分别为(15.6±2.8)、(26.2±6.9)分,cobb角分别为19.5°±1.7°、20.8°±0.8°,椎体前缘高度分别为(20.7±1.4)、(18.7±1.5)mm,均较术前显著改善,差异均有统计学意义(P<0.05);术后6个月观察组与对照组Kümmell病患者VAS评分分别为(1.6±0.6)、(2.7±1.0)分,ODI指数分别为(14.2±3.1)、(21.5±4.2)分,cobb角分别为18.6°±1.8°、19.0°±1.7°,椎体前缘高度分别为(19.9±1.8)、(17.8±1.6)mm,与术后1 d比较,差异均无统计学意义(P>0.05)。术后1 d观察组患者的VAS评分、ODI指数、cobb角和椎体前缘高度均较对照组有显著改善,差异均有统计学意义(P<0.05)。术后6个月观察组患者的VAS评分、ODI指数和椎体前缘高度均较对照组有显著改善,差异均有统计学意义(P<0.05),但两组cobb角差异无统计学意义(P>0.05)。观察组无并发症发生,对照组有6例患者发生骨水泥渗漏。结论相比普通C型臂X线机,Iso-C三维导航系统辅助PKP/PVP治疗Kümmell病可更有效地恢复椎体高度、矫正后凸畸形、缓解患者疼痛、改善生活质量,是实现Kümmell病的个体化精准手术治疗的有效方法。

Objective To compare the Iso-C 3D navigation system versus the traditional X-ray fluoroscopy in minimally invasive surgery for Kümmell disease.Methods Included for the present retrospective study were 42 patients with Kümmell disease who had been treated by percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)at Department of Spine Surgery,Honghui Hospital from October 2016 to June 2018.They were 11 men and 31 women,aged from 43 to 72 years(average,57.4 years).The operation was aided by Iso-C 3D navigational system in 21 patients(observation group)and by X-ray fluoroscopy in the other 21 patients(control group).The 2 groups were compared before operation,one day and 6 months after operation in terms of visual analogue scale(VAS),Oswestry disability index(ODI),cobb angle and anterior vertebral height.Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data(P>0.05).All the patients were followed up for an average of 9.6 months(from 6.0 to 18.5 months).At one day after operation for the observation and control groups,the VAS scores(2.2±0.7 and 3.9±1.5),ODI scores(15.6±2.8 and 26.2±6.9),cob angles(19.5°±1.7°and 20.8°±0.8°)and anterior vertebral heights(20.7±1.4 and 18.7±1.5 mm)were all significantly improved compared with those before operation(P<0.05).At 6 months after operation for the observation and control groups,the VAS scores(1.6±0.6 and 2.7±1.0),ODI(14.2±3.1 and 21.5±4.2),cob angles(18.6°±1.8°and 19.0°±1.7°)and anterior vertebral heights(19.9±1.8 and 17.8±1.6 mm)were not significantly different from those at one day after operation(P>0.05).The VAS,ODI,cobb angle and anterior vertebral height at one day after operation for the observation group were all significantly better than those for the control group(P<0.05).The VAS,ODI and anterior vertebral height at 6 months after operation for the observation group were significantly better than for the control group(P<0.05),but there was no significant difference between the 2 groups in the cobb angle(P>0.05).No complications were observed in the observation group but 6 cases in control group reported cement leakage.Conclusion In the PKP/PVP treatment of Kümmell disease,Iso-C 3D navigational system may be superior to traditional X-ray fluoroscopy in that it can lead to better recovery of anterior vertebral height,kyphosis correction,pain relief and quality of life.