实时三维导航辅助微创经椎间孔腰椎椎间融合术后腰骶部矢状位平衡参数变化分析

目的:探讨实时三维导航辅助微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与传统开放TLIF术治疗腰椎退行性疾病后腰骶部矢状位参数的动态变化。方法:回顾性分析2017年9月至2019年9月行单节段手术治疗的腰椎退行性疾病患者61例。其中导航辅助MIS-TLIF组患者31例,传统开放TLIF组患者30例。收集两组患者的基本信息、手术时间、术中出血量,测量患者术前及术后3个月随访时矢状位影像学参数:腰椎前凸角(lumbar lordosis,LL),节段前凸角(segmental lordosis,SL),骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS),融合节段的椎间隙前高(anterior disc height,ADH)和椎间隙后高(posterior disc height,PDH),计算椎间隙平均高度(disc height,DH),骨盆-腰椎匹配值(pelvic incidence to lumbar lordosis mismatch,PI-LL)。结果:导航辅助MIS-TLIF组手术时间、术中出血量显著少于传统开放TLIF组(P<0.05)。导航辅助MIS-TLIF组患者术后3个月的LL、SL、PI-LL、DH与术前比较有明显改善(P<0.05),而PI、PT、SS与术前相比较,差异无统计学意义(P>0.05)。传统开放TLIF组患者术后3个月的LL、PI-LL、DH与术前比较有明显改善(P<0.05),而PI、PT、SS、SL与术前比较,差异无统计学意义(P>0.05)。LL的改变值与SL的改变值(r=0.433,P<0.05)有显著相关性;SL的改变值与ADH的改变值(r=0.621,P<0.05),PDH的改变值(r=0.527,P<0.05)有显著相关性。结论:实时导航辅助MIS-TLIF与开放TLIF治疗腰椎退行性疾病患者在短期内均可恢复DH,改善LL及PI-LL,使术后腰骶部矢状面序列的排列更为协调,但只有导航辅助MIS-TLIF能显著提高SL。与开放TLIF相比,实时导航辅助MIS-TLIF治疗腰椎退行性疾病患者具有手术时间短、术中出血少等优点。

Analysis of lumbosacral sagittal balance parameter variation in minimally invasive transforaminal lumbar interbody fusion with real-time 3D navigation techniques

Objective: To explore the dynamic changes of lumbosacral sagittal parameters after real-time three-dimensional navigation assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and traditional open TLIF for treatment of lumbar degenerative disease. Methods: The clinical data of 61 patients with lumbar degenerative disease underwent single-segment surgery from September 2017 to September 2019 were retrospectively analyzed. Among them,31 cases underwent MIS-TLIF with 3D navigation techniques (MIS-TLIF group) and another 30 cases underwent conventional open TLIF(traditional open TLIF group). The basic information,operative time and intraoperative blood loss were collected. The sagittal radiologic parameters were measured before surgery and 3 months after surgery,including lumbar lordosis (LL),segmental lordosis(SL),pelvic incidence (PI),pelvic tilt (PT),sacral slope (SS),anterior disc height (ADH),posterior disc height(PDH).And the average disc height(DH) and pelvic incidence to lumbar lordosis mismatch (PI-LL) were calculated. Results: Operative time and intraoperative blood loss in MIS-TLIF group were significantly less than in traditional open TLIF group(P<0.05). In MIS-TLIF group,LL,SL,PI-LL,and DH were significantly improved at 3 months after surgery (P<0.05),while PI,PT,and SS were not statistically different from those before surgery(P>0.05). LL,PI-LL,and DH of patients in the traditional open TLIF group were significantly improved at 3 months after surgery(P<0.05),while the PI,PT,SS,and SL were not statistically different from those before surgery(P>0.05). LL change showed a significant correlation with SL change(r=0.433,P<0.001). Change in SL closely correlated to change in ADH (r=0.621,P<0.05) and PDH(r=0.527,P<0.05). Conclusion: Real-time navigation-assisted MIS-TLIF and traditional open TLIF can recover DH in a short term for lumbar degenerative diseases,improve LL and PI-LL,and make the arrangement of the sagittal plane of the lumbosacral region more coordinated after surgery. But only the navigation assisted MIS-TLIF can significantly improve SL. Compared with traditional open TLIF,real-time navigation assisted MIS-TLIF in the treatment of degenerative lumbar diseases has the advantages of short operation time and less intraoperative bleeding.