Yang Xiaofei, Wu Hongfu
Department of Orthopedics, Affiliated Hospital of Jiangnan University, Wuxi, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):7180-7193. doi: 10.21037/qims-23-319. Epub 2023 Sep 1.
With the increasing aging of the population, the incidence of lumbar disc herniation (LDH) is gradually increasing. The 3-dimensional (3D) computed tomography (CT) navigation-assisted intervertebral foraminoscopic surgery for LDH is minimally invasive, and due to its localization and guidance features, it can precisely reach the target location. This study sought to investigate the treatment effect and the incidence of postoperative complications of 3D CT navigation-assisted intervertebral foraminoscopic surgery in elderly patients with LDH to provide a reference basis for improving patient prognosis.
We retrospectively included 213 elderly patients with LDH admitted to our hospital from October 2017 to October 2021 in this study and followed them up for 1 year. Among them, 103 patients (Group A) underwent conventional C-arm fluoroscopy-assisted system alone intervertebral foraminoscopic surgery, and 110 patients (Group B) underwent 3D CT navigation-assisted intervertebral foraminoscopic surgery. The general characteristics of the participants were compiled using a general information questionnaire designed by the investigator. The -test and chi-square test were used to analyze the relationship between the treatment outcomes and surgical modalities. Binary logistics regression was used to analyze the independent risk factors affecting patient outcomes.
The patients who underwent 3D CT navigation-assisted intervertebral foraminoscopic surgery had significantly better outcomes than those who underwent conventional C-arm fluoroscopy-assisted system alone intervertebral foraminoscopic surgery. The binary logistic regression analysis results showed that in addition to the surgical method [odds ratio (OR) =0.258, P=0.042], the history of lumbar trauma (OR =11.001, P=0.005), usual work intensity (OR =4.589, P=0.002), disease duration (OR =3.587, P=0.017), the presence of diabetes (OR =3.315, P=0.026), the presence of a ruptured annulus fibrosus (OR =3.485, P=0.012), the degree of disc degeneration (OR =3.899, P=0.009), and the number of punctures (OR =0.412, P=0.034) were independent risk factors affecting patient outcomes.
3D CT navigation-assisted intervertebral foraminoscopic surgery for LDH effectively reduced the number of punctures, decreased intraoperative bleeding and postoperative drainage volumes, shortened the length of hospitalization, bed rest time and operative time, reduced stress reactions, decreased the degree of low-back pain, and the risk of complications, had better overall efficacy, and significantly improved patient prognosis.
随着人口老龄化的加剧，腰椎间盘突出症（LDH）的发病率逐渐上升。三维（3D）计算机断层扫描（CT）导航辅助下的椎间孔镜手术治疗LDH具有微创性，且因其定位和引导功能，能精确到达目标位置。本研究旨在探讨3D CT导航辅助下的椎间孔镜手术治疗老年LDH患者的疗效及术后并发症发生率，为改善患者预后提供参考依据。
本研究回顾性纳入2017年10月至2021年10月我院收治的213例老年LDH患者，并对其进行1年的随访。其中，103例患者（A组）仅接受传统C型臂透视辅助系统下的椎间孔镜手术，110例患者（B组）接受3D CT导航辅助下的椎间孔镜手术。采用研究者自行设计的一般信息问卷收集参与者的一般特征。采用t检验和卡方检验分析治疗效果与手术方式之间的关系。采用二元逻辑回归分析影响患者预后的独立危险因素。
接受3D CT导航辅助下椎间孔镜手术的患者的治疗效果明显优于仅接受传统C型臂透视辅助系统下椎间孔镜手术的患者。二元逻辑回归分析结果显示，除手术方式外[比值比（OR）=0.258，P=0.042]，腰椎外伤史（OR =11.001，P=0.005）、日常工作强度（OR =4.589，P=0.002）、病程（OR =3.587，P=0.017）、糖尿病的存在（OR =3.315，P=0.026）、纤维环破裂的存在（OR =3.485，P=0.012）、椎间盘退变程度（OR =3.899，P=0.009）以及穿刺次数（OR =0.412，P=0.034）均为影响患者预后的独立危险因素。
3D CT导航辅助下的椎间孔镜手术治疗LDH有效减少了穿刺次数，减少了术中出血量和术后引流量，缩短了住院时间、卧床时间和手术时间，减轻了应激反应，降低了腰痛程度及并发症风险，总体疗效较好，显著改善了患者预后。
