【摘要】：[目的]通過(guò)對(duì)比術(shù)中三維CT導(dǎo)航輔助下微創(chuàng)經(jīng)椎間孔腰椎椎體間融合術(shù)(minimally invasive transforaminal lumbar interbody fusion with Intraoperative Computed Tomography(iCT-MIS-TLIF))、單純微創(chuàng)經(jīng)椎間孔腰椎椎體間融合術(shù)(minimally invasive transforaminal lumbar interbody fusion(M IS-TLIF))與傳統(tǒng)開放經(jīng)椎間孔腰椎椎體間融合術(shù)(conventional open transforaminal lumbar interbody fusion (COTLIF))治療單節(jié)段腰椎退行性疾病的臨床效果差異,探討術(shù)中三維CT導(dǎo)航輔助下微創(chuàng)經(jīng)椎間孔腰椎椎體間融合術(shù)的可行性。[方法]2009年4月至2011年9月45例單節(jié)段腰椎間盤突出患者,根據(jù)患者自己的治療意愿及術(shù)前資料的綜合分析,11例患者采用術(shù)中三維CT導(dǎo)航下微創(chuàng)經(jīng)椎間孔腰椎椎體間融合術(shù)(iCT-MIS-TLIF)進(jìn)行治療,15例患者采用單純微創(chuàng)經(jīng)椎間孔腰椎椎體間融合術(shù)(MIS-TL IF)進(jìn)行治療,19例患者采用傳統(tǒng)開放經(jīng)椎間孔腰椎椎體間融合術(shù)(COTLIF)進(jìn)行治療。比較三組患者在手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、術(shù)后平均住院日和術(shù)后下地時(shí)間的差異,統(tǒng)計(jì)術(shù)前、術(shù)后3天、1.5月、3月、6月、12月、24月Oswestry Disability Index(ODI), Visual Analogue scores (VAS)和X線評(píng)價(jià)治療效果。同時(shí),考慮到術(shù)中三維CT導(dǎo)航對(duì)手術(shù)時(shí)間的影響,單獨(dú)記錄了術(shù)中三維CT導(dǎo)航掃描、注冊(cè)等所需時(shí)間。[結(jié)果]術(shù)后患者均獲得了隨訪,三組患者術(shù)前一般資料、VAS和ODI評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異。術(shù)后45例患者均未出現(xiàn)手術(shù)相關(guān)并發(fā)癥。iCT-MIS-TLIF組手術(shù)時(shí)間顯著高于MIS-TLIF組和COTLIF組(P0.05); iCT-MIS-TLIF組和MIS-TLIF組術(shù)中平均出血量、術(shù)后平均引流量、術(shù)后平均住院日、術(shù)后下地時(shí)間均無(wú)明顯差異(P0.05),且均明顯低于COTLIF組(P0.05)。三組VAS評(píng)分和ODI評(píng)分的隨訪結(jié)果與術(shù)前相比均有顯著改善,且iCT-MIS-TLIF組和MIS-TLIF組術(shù)后3天腰痛VAS評(píng)分、術(shù)后1.5月ODI評(píng)分顯著低于COTLIF組.iCT-MIS-TLIF組術(shù)后6周腰痛VAS評(píng)分顯著低于COTLIF組(P0.05),其余時(shí)間點(diǎn)三組之間評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異,iCT-MIS-TLIF組和MIS-TLIF組之間術(shù)后各時(shí)間點(diǎn)VAS評(píng)分和ODI評(píng)分均無(wú)統(tǒng)計(jì)學(xué)差異。術(shù)后X線評(píng)價(jià)融合率三組無(wú)統(tǒng)計(jì)學(xué)差異。單獨(dú)記錄的術(shù)中三維CT導(dǎo)航自動(dòng)圖像注冊(cè)平均時(shí)間為45.5秒,CT掃描平均時(shí)間為9秒,各患者平均進(jìn)行3.1次的CT掃描。由于術(shù)中三維CT導(dǎo)航導(dǎo)致的手術(shù)暫停時(shí)間平均為5.8分鐘。[結(jié)論]iCT-MIS-TLIF組和MIS-TLIF組均可獲得和傳統(tǒng)COTLIF組相當(dāng)?shù)闹委熜Ч?但相較于傳統(tǒng)COTLIF組,兩組對(duì)患者的損傷程度更小,且術(shù)后短期腰背痛程度較低。iCT-MIS-TLIF組和MIS-TLIF組之間相關(guān)指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異,雖然術(shù)中三維CT導(dǎo)航會(huì)增加患者的放射線暴露劑量,但在解剖結(jié)構(gòu)復(fù)雜的患者中,術(shù)中三維CT導(dǎo)航的輔助顯示出其實(shí)時(shí)性與精確性的特點(diǎn),在無(wú)需過(guò)多剝離軟組織的基礎(chǔ)上,有利于螺釘?shù)陌踩萌搿?br/>[Abstract]:[objective] to compare (minimally invasive transforaminal lumbar interbody fusion with Intraoperative Computed Tomography (iCT-MIS-TLIF), with three-dimensional CT navigation assisted minimally invasive transforaminal lumbar interbody fusion. Simple minimally invasive transforaminal lumbar interbody fusion (minimally invasive transforaminal lumbar interbody fusion (M IS-TLIF) and traditional open transforaminal lumbar interbody fusion (conventional open transforaminal lumbar interbody fusion (COTLIF) for the treatment of single segment lumbar degenerative diseases The clinical effect is different, To explore the feasibility of minimally invasive interbody fusion through intervertebral foramen and lumbar vertebrae assisted by 3 D CT navigation. [methods] from April 2009 to September 2011, 45 patients with single segment lumbar disc herniation were analyzed according to their own treatment intention and preoperative data. Eleven patients were treated with minimally invasive transforaminal lumbar interbody fusion (iCT-MIS-TLIF) under three dimensional CT navigation, and 15 patients were treated by simple minimally invasive transforaminal lumbar interbody fusion (MIS-TL IF). Nineteen patients were treated with traditional open transforaminal lumbar interbody fusion (COTLIF). The difference of operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative average hospitalization time and postoperative landing time were compared among the three groups. Oswestry Disability Index (ODI), was counted as 3 days, 1.5 months, 3 months, 6 months, 12 months and 24 months after operation. Visual Analogue scores (VAS) and X-ray were used to evaluate the therapeutic effect. At the same time, considering the influence of three dimensional CT navigation on the operation time, the time required for the scanning and registration of three dimensional CT navigation was recorded separately. [results] all patients were followed up. There was no significant difference in preoperative general data, VAS and ODI scores among the three groups. The operative time in iCT-MIS-TLIF group was significantly higher than that in MIS-TLIF group and COTLIF group (P0.05). There was no significant difference between the iCT-MIS-TLIF group and the MIS-TLIF group in the mean amount of blood loss, the average drainage volume, the average hospital stay after operation, and the time of landing after operation (P0.05), and were significantly lower than those in the COTLIF group (P0.05). The follow-up results of VAS score and ODI score in the three groups were significantly improved compared with those before operation, and the VAS score of low back pain was significantly improved in iCT-MIS-TLIF group and MIS-TLIF group 3 days after operation. 1.The ODI score of the iCT-MIS-TLIF group was significantly lower than that of the COTLIF group at 1.5 months after operation. The VAS score of the iCT-MIS-TLIF group was significantly lower than that of the COTLIF group at 6 weeks after operation (P0.05), and there was no statistical difference among the three groups at the other time points. There was no significant difference in VAS score and ODI score between iCT-MIS-TLIF group and MIS-TLIF group. There was no significant difference in fusion rate among the three groups. The average time of registration of three dimensional CT navigation images recorded separately was 45.5 seconds and the average time of CT scanning was 9 seconds. The average CT scanning time of each patient was 3.1 times. The average time of suspension due to three-dimensional CT navigation was 5.8 minutes. [conclusion] both iCT-MIS-TLIF group and MIS-TLIF group can obtain the same therapeutic effect as the traditional COTLIF group, but compared with the traditional COTLIF group, the degree of injury in the two groups is less than that in the traditional COTLIF group. There was no significant difference between the iCT-MIS-TLIF group and the MIS-TLIF group. Although the intraoperative three-dimensional CT navigation increased the radiation exposure dose of the patients, it was found that in the patients with complicated anatomical structure, there was no significant difference in the relative indexes between the iCT-MIS-TLIF group and the MIS-TLIF group. The aid of 3D CT navigation during operation shows the characteristics of real-time and accuracy. It is beneficial to the safety of screw placement on the basis of no need to exfoliate too much soft tissue.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.3

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