三维CT导航与传统X线透视引导脊柱内镜下腰椎椎间融合术的比较研究

Comparison of full-endoscopic lumbar interbody fusion guided by computed tomography-based intraoperative navigation and traditional X-ray fluoroscopy:preliminary results

目的:研究三维CT导航技术引导脊柱内镜下腰椎椎间融合术的可行性、技术要点与初步临床疗效。方法:选择2018年6月至2021年10月共56例脊柱内镜下腰椎椎体间融合手术患者进行回顾性研究,根据术中采用的影像学技术分为三维CT导航组和X线透视组。比较两组患者手术时间、围手术期并发症发生率、置钉准确率和手术疗效。采用疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)和改良MacNab评分标准评价手术疗效。采用X线评估每组手术节段椎间隙高度恢复情况。结果:两组患者手术时间差异无统计学意义(P>0.05)。三维CT导航组共3例患者发生并发症,包括cage滑入腹膜后间隙1例、cage下沉1例、出口根不完全损伤1例;X线透视组1例患者出现出口根神经节刺激症状。两组患者并发症发生率差异无统计学意义(P>0.05)。两组患者术后手术节段椎间隙高度较术前显著恢复(P<0.05)。三维CT导航组置钉准确率显著高于X线透视组(99.2%vs.93.3%,P<0.05)。两组患者术后1周及末次随访时腰腿痛VAS评分、JOA评分及ODI均较术前明显改善(P<0.05)。根据改良MacNab评分标准,两组患者疗效差异无统计学意义(P>0.05)。结论:三维CT导航引导脊柱内镜下腰椎椎间融合术安全、可行,初步疗效满意。与传统X线透视比较,其置钉准确率更高且可以减少透视次数。

Objective:To explore the application of computed tomography based intraoperative navigation in the whole procedure of full-endoscopic lumbar interbody fusion,and to study its feasibility,technical notes and preliminary clinical results.Methods:Totally 56 cases treated by full-endoscopic lumbar interbody fusion between June 2018 and October 2021 were enrolled to this study.All cases were divided into three-dimension tomographic navigation group(navigation group)and traditional fluoroscopic guidance group(fluoroscopy group)according to different intraoperative radiologic technique.The operation time,perioperative complications and the accuracy of percutaneous pedicle screw implantation were compared between the two groups.Clinical results were assessed by visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score,Oswestry disability index(ODI)and modified MacNab criteria,and the improvement of intervertebral space height was measured base on X-ray images.Results:No significant differences of operation time were found between the two groups(P>0.05).There were 3 cases with perioperative complications in navigation group,including intervertebral cage slipped into retroperitoneal space in a case,subsidence of intervertebral cage in a case and incomplete injury of exiting nerve root in a case respectively.There was one case with stimulation symptom of ganglion of exit root nerve in fluoroscopy group.There was no significant difference of incidence of complications between the two groups(P>0.05).The accuracy rate of percutaneous pedicle screw implantation was 99.2% in navigation group and 93.3% in fluoroscopy group respectively,which the difference was statistically significant(P<0.05).The VAS,JOA score and ODI were significantly improved respectively at one week postoperatively and at the last follow-up compared with those preoperatively in each group(P<0.05).The postoperative intervertebral space height was statistically increased in comparison with those preoperatively(P<0.05).No significant differences of the good and excellent rate according to modified MacNab were found between the two groups(P>0.05).Conclusions:CT navigation-guided fullendoscopic lumbar interbody fusion is feasible and safe,which can achieve satisfied preliminary clinical results,higher accuracy of percutaneous pedicle screw implantation,and reduction of X-ray exposure compared to traditional X-ray fluoroscopic guidance.