O型臂X线机与C型臂X线机引导经皮置钉在双通道内镜下减压椎间融合术中应用的对比研究

Comparative study of O-arm and C-arm guided percutaneous screw placement in unilateral biportal endoscopic transforaminal lumbar interbody fusion

中文关键词:  腰椎融合术  双通道内镜  O型臂X线机导航

英文关键词:Lumbar interbody fusion  Biportal endoscopy  O-arm navigation

中文摘要:

  【摘要】 目的：对比分析O型臂X线机与C型臂X线机引导经皮置钉在双通道内镜下经椎间孔减压椎间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）中的应用。方法：回顾性分析2020年1月1日~2020年9月30日于我院接受UBE-TLIF治疗的腰椎退行性疾病患者50例。其中男性25例，女性25例，年龄23~80岁（58.9±12.8岁）。根据术中经皮椎弓根螺钉置钉导航设备的不同分为O臂组（27例）和C臂组（23例）。O臂组男性17例，女性10例，年龄23～80岁（58.8±14.3岁）；C臂组男性8例，女性15例，年龄27～76岁（59.0±10.9岁）。比较两组手术时间、术中出血量、术后住院天数，术后1周内通过Gertzbein-Robbins（G-R）分级评估置钉准确性；术前及术后3个月进行Oswestry功能障碍指数（Oswestry disability index，ODI）评定、腰部及下肢疼痛视觉模拟（visual analog scale，VAS）评分，术后3个月通过改良Macnab疗效指标评估临床疗效。统计并比较两组手术并发症、翻修率情况。结果：O臂组手术时间为196.0±37.5min，C臂组为260.9±69.4min，差异有统计学意义（P＜0.05）。O臂组出血量为108.1±149.6ml，C臂组为106.5±108.0ml；O臂组术后住院天数为5.3±1.7d，C臂组为5.2±1.6d，差异均无统计学意义（P＞0.05）；术后1周O臂组置钉Gertzbein-Robbins（G-R）分级优于C臂组（P＜0.05）。两组术后3个月VAS、ODI评分均较术前显著改善（P＜0.05）。O臂组与C臂组Macnab疗效指标优良率分别为93%和91%，差异无统计学意义（P＞0.05）。O臂组手术并发症发生率为7.4%（2/27）与C臂组为8.7%（2/23），两组间差异无统计学意义（P＞0.05），经保守治疗后患者康复出院。两组均无翻修病例。结论：与C型臂X线机相比，O型臂X线机引导可以提高UBE-TLIF经皮置钉的精确性、缩短手术时间，具有良好的辅助置钉作用。

英文摘要:

  【Abstract】 Objectives: To compare and analyze the application of O-arm and C-arm guided percutaneous screw placement in unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF). Methods: A retrospective analysis was made on 50 patients with lumbar degenerative disease treated by UBE-TLIF from January 1, 2020 to September 30, 2020 in our hospital, including 25 males and 25 females, averaged age was 58.9±12.8 years (23-80 years old). The patients were divided into O-arm group(27 cases) and C-arm group(23 cases) according to the technique of Percutaneous pedicle screw placement. The O-arm group consisted of 17 males and 10 females, averaged age was 58.8±14.3 years(23-80 years old), while the C-arm group consisted of 8 males and 15 females, averaged age was 59.0±10.9 years(27-76 years old). The operation time, intraoperative bleeding, postoperative hospital stay, and the accuracy of screw placement [Gertzbein-Robbins (G-R) grading was used to evaluate the accuracy of screw placement 1 week after surgery] were compared between the two groups. The preoperative and 3-month post-operative Oswestry disability index(ODI) and visual analogue scale(VAS) for back and leg pain were evaluated, and 3-month post-operative modified Macnab criteria(Macnab) were used to evaluate the clinical efficacy. Surgical complications and revision rate were compared between the two groups. Results: The average operation time of O-arm group and C-arm group was 196.0±37.5min and 260.9±69.4min, respectively, the difference was statistically significant(P<0.05). The mean bleeding volume was 108.1±149.6ml and 106.5±108.0ml, and the average length of postoperative hospital stays were 5.3±1.7 days and 5.2±1.6 days, respectively. There was no significant difference between the two groups in the mean bleeding volume and the mean length of postoperative hospital stays(P>0.05). Gertzbein Robbins (G-R) grading of the O-arm group was better than that of the C-arm group(P<0.05). The VAS and ODI scores of both groups were significantly improved 3 months after operation compared to those before operation(P<0.05). The modified Macnab criteria were used to evaluate the clinical outcomes after operation, the excellent and good rates of the O-arm group and C-arm group were 93% and 91%, respectively, with astatistically significantdifference(P>0.05). The surgical complication rate of the O-arm group was 7.4%(2/27), and that of the C-arm group was 8.7%(2/23), the difference was not statistically significant(P>0.05). After conservative treatment, the patients recovered and were discharged without revision. Conclusions: Compared with C-arm, the use of O-arm can effectively improve the accuracy of percutaneous screw placement of UBE-TLIF shorten the operation time, and has a good role of auxiliary screw placement.