三维导航技术在微创经椎间孔入路腰椎椎间融合术中的应用

Application of 3D navigation technology in minimally invasive transforaminal lumbar interbody fusion

目的探讨术中三维导航技术在微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中的应用价值。方法2016年1月-2017年12月采用MIS-TLIF治疗腰椎退行性疾病患者64例,其中32例术中应用三维导航(A组),另32例术中采用传统C形臂X线机透视(B组)。记录并比较2组手术时间、术中出血量、术中辐射量、置钉准确率及每枚螺钉置入时间,采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及日本骨科学会(JOA)评分评价临床疗效,记录并发症发生情况。结果所有手术顺利完成。所有患者随访24~48个月,平均29.5个月。A组手术时间、术中出血量、置钉准确率及每枚螺钉置入时间优于B组,而术中辐射量则高于B组,差异均有统计学意义(P<0.05)。2组术后VAS评分、ODI及JOA评分均较术前显著改善,差异有统计学意义(P<0.05);组间差异无统计学意义(P>0.05)。所有患者术中、术后均无明显并发症发生。结论MIS-TLIF术中应用三维导航技术可提高置钉准确率,缩短手术时间,提高手术的便利性和安全性。

Objective To explore the application value of 3D navigation technology in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).Methods From January 2016 to December 2017,64 patients with degenerative lumbar disease were treated with MIS-TLIF,of which 32 cases were assisted by intraoperative 3D navigation techniques(group A),and the other 32 cases received traditional C-arm X-ray fluoroscopy(group B).The operation time,intraoperative blood loss,intraoperative radiation dose,screw placement accuracy and inserting time of each screw of the 2 groups were recorded and compared.The clinical efficacy was evaluated by pain visual analogue scale(VAS)score,Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score,and the incidence of complications was recorded.Results All the operations were successfully completed.All the patients were followed up for 24-48 months,mean 29.5 months.The operation time,intraoperative blood loss,screw placement accuracy and inserting time of each screw in group A were better than those in group B,while the intraoperative radiation dose was higher than that in group B,all with a statistical significance(P<0.05).The VAS score,ODI and JOA scores of the 2 groups were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05);there was no significant difference between the 2 groups(P>0.05).There were no obvious complications during and after operation in all the patients.Conclusion The application of 3D navigation technology in MIS-TLIF can improve the screw placement accuracy,shorten the operation time,and improve the convenience and safety of the operation.