电磁导航辅助经皮椎弓根置钉在单侧双通道内镜下单节段腰椎椎间融合术中的应用

Application of electromagnetic navigation assisted percutaneous pedicle screw placement in unilateral biportal endoscopic single-level lumbar interbody fusion

中文关键词:  腰椎退行性疾病  经椎间孔腰椎椎体间融合术  单侧双通道脊柱内镜  电磁导航

英文关键词:Lumbar degenerative disease  Transforaminal lumbar interbody fusion  Unilateral biportal endoscopic spinal surgery  Electromagnetic navigation

中文摘要:

  【摘要】 目的：评估电磁导航辅助经皮椎弓根置钉在单侧双通道内镜下经椎间孔腰椎椎体间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）中的应用价值。方法：回顾性分析2020年8月~2021年8月应用电磁导航辅助经皮椎弓根置钉UBE-TLIF治疗的34例单节段腰椎退行性疾病患者的临床资料，其中男18例，女16例；年龄43~73岁（58.4±9.4岁），体质指数24.6±2.9kg/m2；L2/3 1例，L3/4 5例，L4/5 17例，L5/S1 11例（电磁导航组）。以同时间段在C型臂X线机透视辅助经皮椎弓根置钉UBE-TLIF治疗的20例患者作为对照，其中男11例，女9例；年龄35~73岁（58.1±10.2岁），体质指数26.5±3.8kg/m2；L1/2 1例，L2/3 1例，L3/4 3例，L4/5 12例，L5/S1 3例（C型臂透视组）。统计两组患者手术时间、透视次数、置钉时间、置钉准确率及并发症发生情况；在术前和术后1周、3个月及末次随访时进行疼痛视觉模拟评分（visual analogue scale，VAS），术前、术后3个月和末次随访时进行Oswestry功能障碍指数（Oswestry disability index，ODI）评定，末次随访时采用改良MacNab标准评估临床疗效。结果：所有患者均顺利完成手术，电磁导航组和C型臂透视组置钉时间、透视次数、总手术时间分别为30.4±3.3min、3.6±1.0次、173.8±23.9min和44.1±6.1min、22.8±4.9次、190.2±12.5min，电磁导航组均较对照组少（P<0.05），两组置钉准确率无显著性差异（97.1% vs 95.0%，P>0.05）；术后均未出现严重并发症，未行翻修手术。随访6~27个月（平均17.6个月），两组患者术后各时间点的腰背痛、腿痛VAS评分及ODI均较术前显著改善（P<0.05），两组同时间点比较均无显著性差异（P>0.05）。两组末次随访时临床效果优良率无显著性差异（97.1% vs 95.0%，P>0.05）。结论：电磁导航辅助经皮椎弓根置钉UBE-TLIF治疗单节段腰椎退行性疾病具有良好的可行性，术中透视次数少，安全性较高，近期疗效满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the value of electromagnetic navigation assisted percutaneous pedicle screw placement in unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF). Methods: The clinical data of 34 patients with single-level lumbar degenerative diseases treated with UBE-TLIF assisted with electromagnetic navigation for percutaneous pedicle screw placement between August 2020 and August 2021 were retrospectively analyzed, and there were 18 males and 16 females, aged 43-73 years(58.4±9.4 years) with body mass index of 24.7±2.9kg/m2; 1 case was of L2/3, 5 cases were of L3/4, 17 cases were of L4/5 and 11 cases were of L5/S1(electromagnetic navigation group). A total of 20 patients treated with UBE-TLIF assisted with C-arm X-ray machine fluoroscopy for percutaneous pedicle screw placement during the same period were selected as the control group, which consisted of 11 males and 9 females, aged 35-73 years(58.1±10.2 years), with body mass index of 26.5±3.8kg/m2; 1 case was of L1/2, 1 case was of L2/3, 3 cases were of L3/4, 12 cases were of L4/5 and 3 cases were of L5/S1(C-arm fluoroscopy group). The operative time, fluoroscopy times, screw placement time, screw placement accuracy rate, and complications of the two groups were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were evaluated before and after surgery. The modified MacNab criteria were used to evaluate the clinical effect at final follow-up. Results: All the patients successfully completed operation. The screw placement time, number of fluoroscopy times and operative time were 30.4±3.3min, 3.6±1.0, 173.8±23.9min in electromagnetic navigation group and 44.1±6.1min, 22.8±4.9, 190.2±12.5min in C-arm fluoroscopy group, which were significantly lower in the electromagnetic navigation group(P<0.05). The accuracy of pedicle screw placement was comparable between the two groups(97.1% vs 95%, P>0.05). There were no serious complications and revision surgery. With a mean follow-up of 17.6(6-27) months, the VAS back pain, VAS leg pain and ODI in both groups were significantly improved compared with those before surgery at all time points after operation(P＜0.05), and there was no significant difference between the two groups at the same time point(P＞0.05). According to MacNab criteria, there was no significant difference between the two groups in the rate of excellent and good results at final follow-up(97.1% vs 95%, P>0.05). Conclusions: UBE-TLIF assisted with electromagnetic navigation for percutaneous pedicle screw placement is feasible and safety in the treatment of single-level lumbar degenerative disease, with few intraoperative fluoroscopy times, high safety, and satisfactory early results.