无体位改变的导航辅助侧方腰椎间融合术

Navigation assisted lateral lumbar interbody fusion in the unchanged lateral position

摘要:

［目的］介绍无体位改变导航辅助侧方腰椎间融合术的手术技术和初步临床效果。［方法］2017 年 10 月—2019 年 5 月，采用无体位改变导航辅助侧方腰椎间融合术治疗退变性腰椎滑脱症患者 27 例。取右侧卧位，首先完成侧方入路椎间盘切除及融合器置入。然后，不改变体位，将导航参考架固定于左侧髂嵴，O 形臂 X 线机扫描获取手术节段三维图像并传输至导航主机，在导航实时引导下完成经皮椎弓根钉-棒固定。［结果］ 所有患者均顺利完成手术，无严重并发症。27 例患者共置入椎弓根螺钉 122 枚，平均置钉时间 （9.22±3.84） min/枚；按照 Gertzbein-Robbins 分级标准，置钉准确率为 93.44%。所有患者均获随访 3~24 个月，末次随访时腰痛、腿痛 VAS 评分和 ODI 评分、术后滑脱率、椎间隙高度和硬膜囊面积均较术前显著改善 （P<0.05）。按改良 MacNab 标准临床效果优良率 100%。［结论］无体位改变导航辅助侧方腰椎间融合术是一种安全高效的手术方法。

Abstract:

[Objective] To introduce the surgical technique and primary clinical outcomes of navigation assisted lateral lumbar inter- body fusion in the unchanged lateral position. [Methods] From October 2017 to May 2019, 27 patients underwent abovementioned surgical procedures for degenerative lumbar spondylolisthesis. As the patients were placed in right lateral position, discectomy and cage implanta- tion of the involved disc were firstly conducted though a small incision on the left side. Subsequently, maintaining the position unchanged, the navigation reference fixed on the left iliac crest and the segmental three-dimensions images were obtained by O-arm fluoroscopy and transferred to navigator. Finally, percutaneous pedicle screw-rod placement was performed under real-time navigation guidance. [Results] All the 27 patients had operation performed smoothly without serious complications. A total 122 pedicle screws were placed in the 27 pa- tients with an average screw placement time of (9.22±3.84) min/screw and accuracy of pedicle screw placement of 93.4% based on Gertz- bein-Robbins criteria. At the latest follow-up ranged from 3 to 24 months, the ODI and VAS scores for low back pain and leg pain, as well as the slippage rate, intervertebral space height and cross-sectional of the dural sac measured on radiographs significantly improved com- pared with those preoperatively (P<0.05) . According to MacNab's criteria, the excellent and good rate of clinical outcome was 100%. [Conclusion] This navigation assisted lateral lumbar interbody fusion in the unchanged lateral position is a safe and high-efficient surgical tech- nique.