C臂机导航下经皮椎弓根钉内固定联合对侧微创TLIF治疗腰椎管狭窄症

目的 探讨导航辅助下经皮椎弓根钉内固定,联合对侧微创经椎间孔椎体间融合术(Transforaminal Lumbar Interbody Fusion,TLIF),治疗腰椎管狭窄症的临床应用.方法 2010年6月至2012年6月,对47例腰椎管狭窄症患者行导航下经皮椎弓根钉内固定,联合对侧微创TLIF术治疗,观察手术时间、出血量以及手术前后的VAS和ODI评分,并将经皮钉侧和开放置钉侧进行配伍对照比较.结果 平均出血量为(420±45) mL；术前VAS评分为(6.85±1.03),术后1月VAS评分为(1.88±0.79)；术前ODI评分为(31.6±3.05),术后1月ODI评分为(43.1±3.23).配伍对照研究结果显示,经皮钉组A级101枚、B级9枚、C级2枚,开放置钉组A级86枚、B级21枚、C级4枚、D级1枚.经皮钉组平均置钉时间为(11.25±4.33) min,透视次数为(2.73±0.42)次,开放置钉组平均置钉时间为(15.43±5.65) min,透视次数为(4.12±0.85)次.差异均有统计学意义.结论 导航辅助下经皮椎弓根钉内固定,联合对侧微创TLIF治疗腰椎管狭窄症疗,效果显著,导航辅助下经皮钉组置钉术的准确度优于开放置钉组,透视次数和置钉时间均少于开放组.

Percutaneous Pedicle screw Fixation Combine with Contralateral MIS -TLIF Under C -arm Navigation in the Treatment of Lumbar Stenosis

Objective To investigate the outcome of percutaneous pedicle screw fixation combine with contralateral MissTLIF under c-arm navigation in the treatment of lumbar stenosis.Methods From June 2010 to June 2012,47 patients with lumbar stenosis underwent the operation of percutaneous pedicle screw fixation combine with contralateral Miss-TLIF under c-arm navigation.The operating time,blood loss,pre-and post-operative VAS and ODI were documented.A controlled cohort study was made for percutaneous pedicle screw fixation and traditional pedicle screw placement.Results The mean blood loss was（420±45） mL.Mean pre-operative VAS was 6.85±1.03 and 1 month post-operative VAS was 1.88±0.79.Mean pre-operative ODI was 31.6±3.05 and 1 month post-operative ODI was 43.1±3.23.In navigation group,grade A was in 101 screws,B in 9 screws and C in 2 screws.And in traditional group,grade A in 86 crews,B in 21 screws,C in 4 screws and D in 1 screw.Average screw insertion time was（11.25±4.33） min and mean X-ray exposure was 2.73±0.42 in navigation group.Average screw insertion time was（15.43±5.65） min and mean X-ray exposure was 4.12±0.85 in traditional group.There were significant differences between the two groups.Conclusion Percutaneous pedicle screw fixation combine with contralateral MIS-TLIF under c-arm navigation could obtain satisfactory results in the treatment of lumbar stenosis.Percutaneous pedicle screw fixation is more accuracy,need less operating time and X-ray exposure than traditional screw placement.