磁导航脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病的疗效观察

Therapeutic effect of magnetic navigation aided endoscopic transforaminal lumbar interbody fusion on degenerative diseases of lumbar spine

中文关键词:  腰椎退行性疾病  腰椎融合术  磁导航  脊柱内镜

英文关键词:Lumbar degenerative disease  Lumbar interbody fusion  Magnetic navigation  Spinal endoscopy

中文摘要:

  【摘要】 目的：观察磁导航辅助脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病的临床疗效。方法：回顾性分析2021年1月~2022年1月在我院行脊柱内镜下腰椎融合术治疗的43例单节段腰椎退行性疾病患者的资料，其中C型臂组23例，磁导航组20例。两组患者的年龄、体重指数（body mass index，BMI）、患病时间、性别、节段、主诊断及慢性病等一般资料均无统计学差异（P>0.05）。比较两组患者的术中透视次数、置钉时间、置钉准确度、手术时间、手术出血量、术后引流量、卧床时间、住院时间和并发症发生情况，术前和术后1个月、3个月及1年的疼痛视觉模拟评分（visual analogue scak，VAS）及腰椎Oswestry功能障碍指数（Oswestry disability index，ODI），术后1年时腰椎CT评估融合情况。结果：磁导航组和C型臂组的透视次数、置钉时间、置钉准确度、手术时间、术中出血量和术后引流量分别为19.95±9.01次、24.80±9.77min、97.50%、163.40±20.77min、69.50±26.90mL、86.25±22.82mL和55.87±7.23次、60.04±5.59min、89.13%、198.87±33.38min、100.43±47.85mL、117.83±54.41mL，磁导航组均优于C型臂组（P<0.05），两组在卧床时间、住院时间和并发症方面均无统计学差异（P>0.05）。术后1个月腰痛VAS评分磁导航组低于C型臂组（P<0.05），术前、术后3个月及术后1年的腰痛VAS评分、下肢痛VAS评分和ODI评分两组比较均无统计学差异（P>0.05）。两组患者术后1个月、3个月和1年的腰痛和下肢痛VAS评分、ODl评分与术前比较均有明显改善（P<0.05）。术后1年腰椎CT评估融合情况，C型臂引导组腰椎Ⅰ级融合17例、Ⅱ级融合6例，磁导航组Ⅰ级融合16例、Ⅱ级融合4例，两组比较无统计学差异（P>0.05）。结论：磁导航脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病短期疗效满意，与C型臂引导脊柱内镜下腰椎融合术的疗效相近，且具有透视次数少、置钉准确性高、创伤出血少等优点。

英文摘要:

  【Abstract】 Objectives: To observe the clinical effect of magnetic navigation aided endoscopic lumbar fusion for single-segment lumbar degenerative diseases(LDD). Methods: A retrospective analysis was performed on 43 patients with single-segment LDD treated with endoscopic lumbar fusion in our hospital from January 2021 to January 2022. The patients were divided into C-arm group(n=23) and magnetic navigation group(n=20). There were no significant difference in age, body mass index(BMI), duration of symptom, gender, segment, principal diagnosis and chronic disease between the two groups(P>0.05). The fluoroscopy times, screw implantation duration, screw placement accuracy, operative time, intraoperative blood loss, postoperative drainage, bed rest time, hospital stay and complication of the two groups were compared. The visual analogue scale(VAS) and Oswestry disability index(ODI) before surgery, at 1 month, 3 months and 1 year after surgery were compared between the two groups. Postoperative fusion was evaluated at 1 year after surgery. Results: The fluoroscopy times, screw implantation duration, screw placement accuracy, operative time, intraoperative blood loss and postoperative blood loss of the magnetic navigation group and the C-arm group were 19.95±9.01 times, 24.80±9.77min, 97.50%, 163.40±20.77min, 69.50±26.90mL, 86.25±22.82mL, and 55.87±7.23 times, 60.04±5.59min, 89.13%, 198.87±33.38min, 100.43±47.85mL, and 117.83±54.41mL. The magnetic navigation group was superior to the C-arm group(P<0.05). There was no significant difference in bed rest time, hospital stay and complication between the two groups(P>0.05). The VAS score of back pain at 1 month after surgery in the magnetic navigation group was significantly lower than that in the C-arm group(P<0.05), and there was no significant differences in back pain VAS score, leg pain pain VAS score and ODI between the two groups before surgery, at 3 months after surgery and 1 year after surgery(P>0.05). The VAS scores and ODl scores of back pain and leg pain in two groups were significantly improved at 1 month, 3 months and 1 year after surgery(P<0.05). Lumbar fusion was evaluated by CT 1 year after surgery. In the C-arm group, there were 17 cases of grade Ⅰ lumbar fusion, 6 cases of grade Ⅱ fusion; In the magnetic navigation group, there were 16 cases of grade Ⅰ fusion and 4 cases of grade Ⅱ fusion; And there was no statistical difference between the two groups(P>0.05). Conclusions: Magnetic navigation aided endoscopic lumbar fusion for the treatment of single-segment LDD has a satisfactory short-term effect, which is similar to the C-arm guided endoscopic lumbar fusion. It has the advantages of fewer fluoroscopy times, higher nail placement accuracy, and less trauma and bleeding.