使用手术显微镜与手术放大镜的微创经椎间孔腰椎椎间融合术的手术结果：一项对比研究

Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Surgical Microscope vs Surgical Loupes: A Comparative Study.

作者信息

Singhatanadgige Weerasak, Chamadol Hathaiphoom, Tanasansomboon Teerachat, Kang Daniel G, Yingsakmongkol Wicharn, Limthongkul Worawat

机构信息

Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.

出版信息

Int J Spine Surg. 2022 Jul 14;16(4):625-30. doi: 10.14444/8303.

DOI:10.14444/8303

PMID:35835571

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9421202/

Abstract

BACKGROUND

Minimally invasive transforaminal interbody fusion (MIS-TLIF) is an effective procedure for lumbar spine diseases. The procedure can be done using a surgical microscope (SM) or surgical loupes (SL) magnification. However, there are no studies that compared outcomes between using these 2 magnifying devices in the MIS-TLIF procedure. The purpose of this study was to compare clinical outcomes, perioperative complications, and radiographic parameters of MIS-TLIF using SM compared with SL magnification.

METHODS

We included all patients undergoing 1-level MIS-TLIF between January 2017 and December 2019. Type of magnification (SM vs SL), operative time, blood loss, perioperative complications, cross-sectional area of the spinal canal, and fusion rates were analyzed. Clinical outcomes measurement using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were compared between groups.

RESULTS

A total of 100 patients had underwent MIS-TLIF (SM group: 62; SL group: 38). Operative time (SM: 182.7 ± 41.5 vs SL: 165.6 ± 32.6 minutes, = 0.043) was significantly shorter in the SL group, with a mean difference of 17.2 minutes and a 10.4% increase in operative time between SL and SM. Blood loss (SM: 187.4 ± 176.4 vs SL: 215.6 ± 99.4 mL, = 0.36) was not different between groups, with a mean difference of 28.2 mL. Both the SM group and SL group demonstrated no significant differences in improvement from baseline in VAS back, VAS legs, ODI score, and cross-sectional area of the spinal canal. There was also no significant difference in complication rates and fusion rates between groups.

CONCLUSIONS

Our study found no difference between intraoperative use of SL compared with SM in clinical outcomes through the 12-month follow-up timepoint. However, the use of SM resulted in an increased average operative time of 17 minutes compared with the SL group.

CLINICAL RELEVANCE

Intraoperative use of SM and SL magnification in MIS-TLIF provides similar outcomes except prolonged operative time in the SM group.

摘要

背景

微创经椎间孔腰椎椎体间融合术（MIS-TLIF）是治疗腰椎疾病的一种有效术式。该手术可在手术显微镜（SM）或手术放大镜（SL）放大条件下进行。然而，尚无研究比较这两种放大设备在MIS-TLIF手术中的疗效。本研究旨在比较使用SM与SL放大设备进行MIS-TLIF手术的临床疗效、围手术期并发症及影像学参数。

方法

纳入2017年1月至2019年12月期间接受单节段MIS-TLIF手术的所有患者。分析放大类型（SM与SL）、手术时间、失血量、围手术期并发症、椎管横截面积及融合率。比较两组采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估的临床疗效。

结果

共有100例患者接受了MIS-TLIF手术（SM组：62例；SL组：38例）。SL组手术时间（SM组：182.7±41.5分钟，SL组：165.6±32.6分钟，P = 0.043）显著更短，平均差异为17.2分钟，SL组与SM组相比手术时间增加了10.4%。两组间失血量（SM组：187.4±176.4毫升，SL组：215.6±99.4毫升，P = 0.36）无差异，平均差异为28.2毫升。SM组和SL组在VAS背痛评分、VAS腿痛评分、ODI评分及椎管横截面积较基线的改善方面均无显著差异。两组间并发症发生率和融合率也无显著差异。