| 导航下单体位斜外侧椎间融合联合经皮椎弓根螺钉固定治疗腰椎退行性疾病的疗效 |
| Clinical efficacy of single-position oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation on computer navigation for treatment of degenerative lumbar diseases |
| 投稿时间：2022-12-12 |
| DOI：10.3969/j.issn.1672-5972.2023.04.001 |
| 中文关键词: 斜外侧椎间融合术 导航 单体位 经皮椎弓根螺钉 |
| 英文关键词:Oblique lumbar interbody fusion Navigation Single position Percutaneous pedicle screws |
| 基金项目:国家自然科学基金面上项目（81372045）；陕西省创新能力支撑计划项目（2021TD-45） |
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| 中文摘要: |
| 目的 探讨导航下单体位斜外侧椎间融合术（oblique lumbar interbody fusion, OLIF）联合经皮椎弓根螺钉（percutaneous pedicle screw, PPS）固定治疗腰椎退行性疾病的可行性和临床疗效。方法 回顾性分析空军军医大学第二附属医院2018年10月至2021年3月采用OLIF联合后路经皮椎弓根螺钉固定治疗腰椎退行性疾病的65例患者，其中35例行右侧卧位OLIF，改俯卧位行后路螺钉固定（变换体位组）；30例行导航下单体位OLIF及后路螺钉固定（导航下单体位组）。记录并比较两组患者的手术时间、手术室占用时间、术中出血量、椎弓根螺钉置钉时间、住院时间及疼痛视觉模拟评分（visual analogue scale, VAS）、Oswestry功能障碍指数（oswestry disability index, ODI）。比较术前及末次随访时的椎间隙高度、椎间孔面积、腰椎前凸角的变化。CT三维重建评估椎弓根螺钉置入的准确性及椎间融合率。结果 两组患者均顺利完成手术，随访12 ～ 18个月，平均（14.9±2.1）个月，无严重并发症发生。导航下单体位组与变换体位组相比，手术时间、手术室占用时间及椎弓根螺钉置钉时间均更短，但术中出血量较多（P＜0.05）。导航下单体位组椎弓根螺钉置钉准确率（98.4%）较变换体位组（94.3%）高，但差异无统计学意义（P＞0.05）；两组患者住院时间比较，差异无统计学意义（P＞0.05）。术后随时间推移，两组患者腰痛及下肢痛VAS评分、ODI评分均显著降低（P＜0.05）。术后3个月和末次随访时，两组间的腰痛及下肢痛VAS评分和ODI评分差异无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时两组椎间隙高度、椎间孔面积、腰椎前凸角均显著增加（P＜0.05），但两组间比较差异均无统计学意义（P＞0.05）。末次随访时两组椎间融合率均为100%，差异无统计学意义（P＞0.05）。结论 导航下单体位OLIF联合后路固定治疗腰椎退行性疾病的早期临床疗效满意，具有手术时间短、置钉快速精准及安全性高的优势。 |
| 英文摘要: |
| Objective To investigate the feasibility and clinical efficacy of single-position oblique lumber interbody fusion (OLIF) combined with percutaneous pedicle screw (PPS) fixation using computer navigation for the treatment of degenerative lumbar degenerative diseases.Methods From October 2018 to March 2021, 65 patients with degenerative lumbar diseases were treated with OLIF combined with posterior percutaneous pedicle screw fixation in the Second Affiliated Hospital of Air Force Medical University of PLA. Among them, 35 patients firstly underwent OLIF in the right lateral decubitus position, subsequently they were placed in prone position and received posterior screw fixation (reposition group); 30 patients underwent single-position OLIF combined with percutaneous pedicle screw fixation on computer navigation (single position group). The operation time, occupancy time in the operating room, intraoperative blood loss, pedicle screw placement time, hospitalization time and visual analogue scale (VAS), Oswestry disability index (ODI) were recorded and compared between the two groups. The changes of disc height, intervertebral foramen area and lumbar lordosis angle were compared before operation and at the last follow-up. The accuracy of pedicle screw insertion and intervertebral fusion rate were evaluated by CT three-dimensional reconstruction.Results All patients in both groups had operation conducted successfully without serious complications. The follow-up time was 12-18 months, with an average of (14.9±2.1) months. The single position group showed shorter operation time, occupancy time of operating room and pedicle screw placement time than those of tradition reposition group (P<0.05), but more intraoperative blood loss (P<0.05). The accuracy of pedicle screw placement in single position group(98.4%) as higher than that in traditional reposition group(94.3%), but the difference was not statistically significant (P>0.05). There was no significant difference in hospitalization time between the two groups (P>0.05). With the passage of time, the VAS scores of low back and leg pain and ODI scores in both groups were significantly decreased (P<0.05). There were no significant differences in VAS scores of low back and leg pain and ODI scores between the two groups at 3 months and at the last follow-up. Radiographically, the disc height, intervertebral foramen area and lumbar lordosis angle in both groups were significantly increased at the last follow-up compared with those before operation (P<0.05), but there was no significant difference in abovesaid imaging indexes. At the last follow-up, the fusion rate was 100% in both groups, with no statistically significant difference (P<0.05).Conclusion The early clinical efficacy of single-position OLIF combined with posterior fixation on computer navigation for the treatment of degenerative lumbar diseases is satisfactory. It has the advantages of short operation time, fast and accurate screw placement, and high safety. |
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