【摘要】：目的:探討計算機導(dǎo)航在工作通道下行極外側(cè)入路胸腰段及腰椎結(jié)核病灶清除植骨內(nèi)固定術(shù)中的作用。方法:2013年6月~2014年10月采用工作通道下行極外側(cè)入路病灶清除植骨內(nèi)固定術(shù)治療胸腰段或腰椎結(jié)核患者46例。所有患者隨機分為導(dǎo)航組(男16例,女7例)和對照組(男14例,女9例),各23例。導(dǎo)航組年齡37.7±16.7歲,對照組年齡39.2±18.4歲。合并神經(jīng)功能障礙17例,導(dǎo)航組7例(ASIA分級C級5例、D級2例),對照組10例(C級6例、D級4例)。術(shù)后門診隨訪記錄植骨融合的時間、VAS評分、ASIA分級及脊柱后凸Cobb角。術(shù)前兩組患者的一般資料、ASIA分級、VAS評分及脊柱后凸Cobb角差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。結(jié)果:導(dǎo)航組術(shù)中出血量為447±139.6ml,對照組為627±251.3ml,兩組有統(tǒng)計學(xué)差異(P0.05)。導(dǎo)航組術(shù)中C型臂X線透視累計曝光時間為31±14.2s,對照組為96±44.6s,兩組有統(tǒng)計學(xué)差異(P0.05)。導(dǎo)航組手術(shù)時間為158±73.6min,對照組為213±88.2min,兩組比較有統(tǒng)計學(xué)差異(P0.05)。對照組切口裂開1例,縫合后治愈;導(dǎo)航組1例術(shù)后1個半月切口形成竇道,換藥治療2個月后治愈。對照組術(shù)前6例C級患者中,術(shù)后6個月時恢復(fù)至D級3例、E級3例;4例術(shù)前D級患者恢復(fù)至E級。導(dǎo)航組術(shù)前5例C級患者中,術(shù)后6個月時恢復(fù)至D級3例、E級2例;2例術(shù)前D級患者恢復(fù)至E級。導(dǎo)航組的VAS評分、脊柱后凸Cobb角及骨融合時間與對照組比較均無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:在工作通道下極外側(cè)入路胸腰段及腰椎結(jié)核病灶清除植骨內(nèi)固定術(shù)中應(yīng)用計算機導(dǎo)航可獲得良好的手術(shù)療效并縮短手術(shù)時間,減少患者及醫(yī)護人員的術(shù)中射線暴露。
[Abstract]:Objective: to investigate the role of computer navigation in bone grafting and internal fixation of thoracolumbar segment and lumbar tuberculosis via polar lateral approach under the working channel. Methods: from June 2013 to October 2014, 46 patients with thoracolumbar or lumbar tuberculosis were treated with focal debridement and bone grafting and internal fixation. All patients were randomly divided into navigation group (M 16, F 7) and control group (M 14, F 9) with 23 cases each. The age of navigation group was 37.7 鹵16.7 years old, and that of control group was 39.2 鹵18.4 years old. There were 17 cases of neurological dysfunction, 7 cases of navigation group (5 cases of ASIA grade C, 2 cases of grade D) and 10 cases of control group (6 cases of grade C and 4 cases of grade D). The time of bone graft fusion, VAS score, ASIA grade and Cobb angle of kyphosis were recorded. There was no significant difference in general data, ASIA grade, VAS score and Cobb angle between the two groups before operation (P 0.05). Results: the intraoperative blood loss was 447 鹵139.6ml in the navigation group and 627 鹵251.3ml in the control group. There was significant difference between the two groups (P 0.05). The cumulative exposure time of C-arm X-ray fluoroscopy was 31 鹵14.2 s in navigation group and 96 鹵44.6 s in control group. There was significant difference between the two groups (P 0.05). The operation time was 158 鹵73.6 min in the navigation group and 213 鹵88.2 min in the control group. There was significant difference between the two groups (P 0.05). In the control group, the incision was cracked in 1 case and cured after suture, and in the navigation group, the sinus was formed 1 and a half months after operation, and cured after 2 months of dressing change treatment. In the control group, 3 cases of grade D and 3 cases of grade E recovered to grade D and 3 cases of grade E before operation, and 4 cases of grade D recovered to grade E before operation. In the navigation group, 5 patients with grade C recovered to grade D and 2 patients to grade E 6 months after operation, and 2 patients recovered to grade E before operation. There was no significant difference in VAS score, Cobb angle and bone fusion time between navigation group and control group (P 0.05). Conclusion: the application of computer navigation in the removal and internal fixation of thoracolumbar and lumbar tuberculosis lesions under the extreme lateral approach under the working channel can obtain good surgical results, shorten the operation time and reduce the intraoperative radiation exposure of patients and medical and nursing staff.
【作者單位】： 廣西貴港市人民醫(yī)院脊柱關(guān)節(jié)科;
【分類號】：R687.3

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