计算机导航在工作通道下行极外侧入路手术治疗脊柱结核术中的应用

发布时间：2019-07-24 19:48

【摘要】：目的:探讨计算机导航在工作通道下行极外侧入路胸腰段及腰椎结核病灶清除植骨内固定术中的作用。方法:2013年6月~2014年10月采用工作通道下行极外侧入路病灶清除植骨内固定术治疗胸腰段或腰椎结核患者46例。所有患者随机分为导航组(男16例,女7例)和对照组(男14例,女9例),各23例。导航组年龄37.7±16.7岁,对照组年龄39.2±18.4岁。合并神经功能障碍17例,导航组7例(ASIA分级C级5例、D级2例),对照组10例(C级6例、D级4例)。术后门诊随访记录植骨融合的时间、VAS评分、ASIA分级及脊柱后凸Cobb角。术前两组患者的一般资料、ASIA分级、VAS评分及脊柱后凸Cobb角差异均无统计学意义(P0.05),具有可比性。结果:导航组术中出血量为447±139.6ml,对照组为627±251.3ml,两组有统计学差异(P0.05)。导航组术中C型臂X线透视累计曝光时间为31±14.2s,对照组为96±44.6s,两组有统计学差异(P0.05)。导航组手术时间为158±73.6min,对照组为213±88.2min,两组比较有统计学差异(P0.05)。对照组切口裂开1例,缝合后治愈;导航组1例术后1个半月切口形成窦道,换药治疗2个月后治愈。对照组术前6例C级患者中,术后6个月时恢复至D级3例、E级3例;4例术前D级患者恢复至E级。导航组术前5例C级患者中,术后6个月时恢复至D级3例、E级2例;2例术前D级患者恢复至E级。导航组的VAS评分、脊柱后凸Cobb角及骨融合时间与对照组比较均无统计学差异(P0.05)。结论:在工作通道下极外侧入路胸腰段及腰椎结核病灶清除植骨内固定术中应用计算机导航可获得良好的手术疗效并缩短手术时间,减少患者及医护人员的术中射线暴露。
[Abstract]:Objective: to investigate the role of computer navigation in bone grafting and internal fixation of thoracolumbar segment and lumbar tuberculosis via polar lateral approach under the working channel. Methods: from June 2013 to October 2014, 46 patients with thoracolumbar or lumbar tuberculosis were treated with focal debridement and bone grafting and internal fixation. All patients were randomly divided into navigation group (M 16, F 7) and control group (M 14, F 9) with 23 cases each. The age of navigation group was 37.7 卤16.7 years old, and that of control group was 39.2 卤18.4 years old. There were 17 cases of neurological dysfunction, 7 cases of navigation group (5 cases of ASIA grade C, 2 cases of grade D) and 10 cases of control group (6 cases of grade C and 4 cases of grade D). The time of bone graft fusion, VAS score, ASIA grade and Cobb angle of kyphosis were recorded. There was no significant difference in general data, ASIA grade, VAS score and Cobb angle between the two groups before operation (P 0.05). Results: the intraoperative blood loss was 447 卤139.6ml in the navigation group and 627 卤251.3ml in the control group. There was significant difference between the two groups (P 0.05). The cumulative exposure time of C-arm X-ray fluoroscopy was 31 卤14.2 s in navigation group and 96 卤44.6 s in control group. There was significant difference between the two groups (P 0.05). The operation time was 158 卤73.6 min in the navigation group and 213 卤88.2 min in the control group. There was significant difference between the two groups (P 0.05). In the control group, the incision was cracked in 1 case and cured after suture, and in the navigation group, the sinus was formed 1 and a half months after operation, and cured after 2 months of dressing change treatment. In the control group, 3 cases of grade D and 3 cases of grade E recovered to grade D and 3 cases of grade E before operation, and 4 cases of grade D recovered to grade E before operation. In the navigation group, 5 patients with grade C recovered to grade D and 2 patients to grade E 6 months after operation, and 2 patients recovered to grade E before operation. There was no significant difference in VAS score, Cobb angle and bone fusion time between navigation group and control group (P 0.05). Conclusion: the application of computer navigation in the removal and internal fixation of thoracolumbar and lumbar tuberculosis lesions under the extreme lateral approach under the working channel can obtain good surgical results, shorten the operation time and reduce the intraoperative radiation exposure of patients and medical and nursing staff.
【作者单位】：广西贵港市人民医院脊柱关节科;
【分类号】：R687.3

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