术中三维CT导航辅助下微创经椎间孔腰椎椎体间融合术的可行性研究

发布时间：2018-11-03 14:45

【摘要】：[目的]通过对比术中三维CT导航辅助下微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion with Intraoperative Computed Tomography(iCT-MIS-TLIF))、单纯微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion(M IS-TLIF))与传统开放经椎间孔腰椎椎体间融合术(conventional open transforaminal lumbar interbody fusion (COTLIF))治疗单节段腰椎退行性疾病的临床效果差异,探讨术中三维CT导航辅助下微创经椎间孔腰椎椎体间融合术的可行性。[方法]2009年4月至2011年9月45例单节段腰椎间盘突出患者,根据患者自己的治疗意愿及术前资料的综合分析,11例患者采用术中三维CT导航下微创经椎间孔腰椎椎体间融合术(iCT-MIS-TLIF)进行治疗,15例患者采用单纯微创经椎间孔腰椎椎体间融合术(MIS-TL IF)进行治疗,19例患者采用传统开放经椎间孔腰椎椎体间融合术(COTLIF)进行治疗。比较三组患者在手术时间、术中出血量、术后引流量、术后平均住院日和术后下地时间的差异,统计术前、术后3天、1.5月、3月、6月、12月、24月Oswestry Disability Index(ODI), Visual Analogue scores (VAS)和X线评价治疗效果。同时,考虑到术中三维CT导航对手术时间的影响,单独记录了术中三维CT导航扫描、注册等所需时间。[结果]术后患者均获得了随访,三组患者术前一般资料、VAS和ODI评分无统计学差异。术后45例患者均未出现手术相关并发症。iCT-MIS-TLIF组手术时间显著高于MIS-TLIF组和COTLIF组(P0.05); iCT-MIS-TLIF组和MIS-TLIF组术中平均出血量、术后平均引流量、术后平均住院日、术后下地时间均无明显差异(P0.05),且均明显低于COTLIF组(P0.05)。三组VAS评分和ODI评分的随访结果与术前相比均有显著改善,且iCT-MIS-TLIF组和MIS-TLIF组术后3天腰痛VAS评分、术后1.5月ODI评分显著低于COTLIF组.iCT-MIS-TLIF组术后6周腰痛VAS评分显著低于COTLIF组(P0.05),其余时间点三组之间评分无统计学差异,iCT-MIS-TLIF组和MIS-TLIF组之间术后各时间点VAS评分和ODI评分均无统计学差异。术后X线评价融合率三组无统计学差异。单独记录的术中三维CT导航自动图像注册平均时间为45.5秒,CT扫描平均时间为9秒,各患者平均进行3.1次的CT扫描。由于术中三维CT导航导致的手术暂停时间平均为5.8分钟。[结论]iCT-MIS-TLIF组和MIS-TLIF组均可获得和传统COTLIF组相当的治疗效果,但相较于传统COTLIF组,两组对患者的损伤程度更小,且术后短期腰背痛程度较低。iCT-MIS-TLIF组和MIS-TLIF组之间相关指标无统计学差异,虽然术中三维CT导航会增加患者的放射线暴露剂量,但在解剖结构复杂的患者中,术中三维CT导航的辅助显示出其实时性与精确性的特点,在无需过多剥离软组织的基础上,有利于螺钉的安全置入。
[Abstract]:[objective] to compare (minimally invasive transforaminal lumbar interbody fusion with Intraoperative Computed Tomography (iCT-MIS-TLIF), with three-dimensional CT navigation assisted minimally invasive transforaminal lumbar interbody fusion. Simple minimally invasive transforaminal lumbar interbody fusion (minimally invasive transforaminal lumbar interbody fusion (M IS-TLIF) and traditional open transforaminal lumbar interbody fusion (conventional open transforaminal lumbar interbody fusion (COTLIF) for the treatment of single segment lumbar degenerative diseases The clinical effect is different, To explore the feasibility of minimally invasive interbody fusion through intervertebral foramen and lumbar vertebrae assisted by 3 D CT navigation. [methods] from April 2009 to September 2011, 45 patients with single segment lumbar disc herniation were analyzed according to their own treatment intention and preoperative data. Eleven patients were treated with minimally invasive transforaminal lumbar interbody fusion (iCT-MIS-TLIF) under three dimensional CT navigation, and 15 patients were treated by simple minimally invasive transforaminal lumbar interbody fusion (MIS-TL IF). Nineteen patients were treated with traditional open transforaminal lumbar interbody fusion (COTLIF). The difference of operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative average hospitalization time and postoperative landing time were compared among the three groups. Oswestry Disability Index (ODI), was counted as 3 days, 1.5 months, 3 months, 6 months, 12 months and 24 months after operation. Visual Analogue scores (VAS) and X-ray were used to evaluate the therapeutic effect. At the same time, considering the influence of three dimensional CT navigation on the operation time, the time required for the scanning and registration of three dimensional CT navigation was recorded separately. [results] all patients were followed up. There was no significant difference in preoperative general data, VAS and ODI scores among the three groups. The operative time in iCT-MIS-TLIF group was significantly higher than that in MIS-TLIF group and COTLIF group (P0.05). There was no significant difference between the iCT-MIS-TLIF group and the MIS-TLIF group in the mean amount of blood loss, the average drainage volume, the average hospital stay after operation, and the time of landing after operation (P0.05), and were significantly lower than those in the COTLIF group (P0.05). The follow-up results of VAS score and ODI score in the three groups were significantly improved compared with those before operation, and the VAS score of low back pain was significantly improved in iCT-MIS-TLIF group and MIS-TLIF group 3 days after operation. 1.The ODI score of the iCT-MIS-TLIF group was significantly lower than that of the COTLIF group at 1.5 months after operation. The VAS score of the iCT-MIS-TLIF group was significantly lower than that of the COTLIF group at 6 weeks after operation (P0.05), and there was no statistical difference among the three groups at the other time points. There was no significant difference in VAS score and ODI score between iCT-MIS-TLIF group and MIS-TLIF group. There was no significant difference in fusion rate among the three groups. The average time of registration of three dimensional CT navigation images recorded separately was 45.5 seconds and the average time of CT scanning was 9 seconds. The average CT scanning time of each patient was 3.1 times. The average time of suspension due to three-dimensional CT navigation was 5.8 minutes. [conclusion] both iCT-MIS-TLIF group and MIS-TLIF group can obtain the same therapeutic effect as the traditional COTLIF group, but compared with the traditional COTLIF group, the degree of injury in the two groups is less than that in the traditional COTLIF group. There was no significant difference between the iCT-MIS-TLIF group and the MIS-TLIF group. Although the intraoperative three-dimensional CT navigation increased the radiation exposure dose of the patients, it was found that in the patients with complicated anatomical structure, there was no significant difference in the relative indexes between the iCT-MIS-TLIF group and the MIS-TLIF group. The aid of 3D CT navigation during operation shows the characteristics of real-time and accuracy. It is beneficial to the safety of screw placement on the basis of no need to exfoliate too much soft tissue.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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