计算机导航联合神经监护在上颈椎椎管内肿瘤手术中的应用效果

Application effect of computer navigation combined with neural monitoring in the operation of upper cervical intraspinal canal tumor

目的评估计算机导航联合神经监护应用于上颈椎椎管内肿瘤手术的临床效果。方法回顾性分析海南医学院第一附属医院2007年1月至2018年4月手术治疗的40例上颈椎椎管内肿瘤患者的临床资料,其中20例为透视组,余20例为导航联合神经监护组。分别于术前及术后3个月随访时按日本骨科协会(JOA)颈椎疗效评定标准评估患者疗效,同时比较两组患者的手术操作时间、术后ICU治疗时间以及恢复下地活动时间。结果两组患者肿瘤均得到完整切除;两组患者术后3个月的JOA评分均较术前有所改善,但导航联合神经监护组患者术后3个月JOA的评分为(13.1±1.8)分,明显高于透视组的(11.7±1.4)分,JOA改善率为(52.3±22.4)%,明显高于透视组的(29.3±20.5)%,差异均具有统计学意义(P<0.05);同时导航联合神经监护组与透视组患者的手术时间[(217.0±30.0)min vs(282.6±57.1)min]、术后ICU治疗时间[(3.8±1.0)d vs(6.2±1.2)d]及恢复下地活动时间[(6.5±0.7)d vs(10.8±2.8)d]比较,导航联合神经监护明显短于透视组,差异均具有统计学意义(P<0.05)。结论术中导航联合神经监护可显著提高上颈椎椎管内肿瘤手术的临床效果。

Objective To evaluate the clinical effect of intraoperative computer navigation combined with neural monitoring in the operation of upper cervical intraspinal canal tumor.Methods The clinical data of 40 patients,who accepted surgical treatment of the upper cervical intraspinal canal tumor in the First Affiliated Hospital of Hainan Medical University from January 2007 to April 2018,were retrospectively analyzed,of which 20 patients were in the fluoroscopic group and another 20 were in the navigation combined with neural monitoring group.All patients were evaluated according to the Japanese orthopedic association(JOA)cervical spine efficacy evaluation criteria at the preoperative and postoperative 3 months respectively.The data of operating time,postoperative ICU treatment time,and the time of early ambulation were compared between the two groups.Results T tumors of the two groups of patients were completely resected.Compared with the preoperative JOA score,both groups scored higher in at postoperative 3 months,but the navigation combined with neural monitoring group scored 13.1±1.8,which was significantly higher than 11.7±1.4 in the fluoroscopic group(P<0.05).The JOA improvement rate in the navigation combined with neural monitoring group was(52.3±22.4)%,which was significantly lower than(29.3±20.5)%in the fluoroscopic group(P<0.05).The operating time,postoperative ICU treatment time,and the early ambulation time were(217.0±30.0)minutes,(3.8±1.0)days and(6.5±0.7)days in the navigation combined with neural monitoring group,respectively,which were significantly shorter than corresponding(282.6±57.1)minutes,(6.2±1.2)days and(10.8±2.8)days in the fluoroscopic group(P<0.05).Conclusion Intraoperative navigation combined with neural monitoring can significantly improve the clinical effect of upper cervical intraspinal canal tumor surgery.