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

Application of computer navigation in the treatment of spinal tuberculosis in the extreme lateral interbody fusion under working channel

中文关键词:  胸腰椎结核  结核病灶清除  计算机导航  极外侧入路椎间融合术

英文关键词:Thoracic and lumbar tuberculosis  Tuberculosis focus clearance  Computer navigation  Extreme lateral interbody fusion

中文摘要:

  【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（P>0.05），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（P<0.05）。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（P<0.05）。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（P<0.05）。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（P>0.05）。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。

英文摘要:

  【Abstract】 Objectives: To investigate computer navigation in the extreme lateral interbody fusion(XLIF) under working channel for thoracolumbar and lumbar tuberculosis. Methods: From June 2013 to October 2014, 46 cases of thoracolumbar or lumbar tuberculosis underwent the XLIF under working channel. Patients were randomly divided into navigation group(16 males, 7 females) and control group(14 males, 9 females), 23 cases in each group. The average age of navigation group was 37.7±16.7 years old, and the average age of control group was 39.2±18.4 years old. 17 cases were complicated with nerve dysfunction(7 cases in navigation group, 10 cases in control group), American Spinal Injury Association(ASIA) grade was used to evaluate neurofunction: in navigation group, there were 5 cases of grade C, 2 cases of grade D, while in control group, there were 6 cases of grade C, 4 cases of grade D. Postoperative outpatient follow-up records included erythrocyte sedimentation rate, bone fusion time, visual analogue score(VAS) score, ASIA grade and Cobb angle lesions. Preoperative general information and ASIA classification, VAS score and Cobb angle of spine comparison between two groups were not statistically significant(P>0.05). Results: The intraoperative bleeding in navigation group was 447±139.6ml, while 627±251.3ml in control group, the difference showed statistical significance(P<0.05). The intraoperative C arm fluoroscopy exposure time was 31±14.2s in navigation group, and 96±44.6s in control group, the difference had statistical significance(P<0.05). Operation time was 158±73.6min in navigation group, and 213±88.2min in control group, the difference had statistical significance(P<0.05). The VAS score, kyphosis angle(Cobb angle), operation time, bone fusion time showed no significant difference between the two groups. 10 cases in control group had preoperative neurological injury, among 6 cases of grade C, 3 cases recovered to grade D after surgery, 3 cases recovered to grade E. 4 grade D patients recovered to grade E. Neurolgical injury was noted in 7 cases in navigation group, after operation, among 5 cases of grade C, 3 cases recovered to grade D, 2 cases recovered to grade E. 2 grade D patients recovered to grade E. 1 cases of incision non-healing occurred in control group, and it cured after suture. 1 case of incision sinus occurred in navigation group, and it cured by dressing treatment after 2 months. Conclusions: Thoracolumbar and lumbar tuberculosis debridement, internal fixation and bone grafting through XLIF under computer navigation can obtain a good surgical effect and shorten the operation time, reduce intraoperative radiation exposure.