Union Shenzhen Hospital (Nanshan Hospital) ，Huazhong University of Science and Technology
[目的] 介绍导航辅助同一体位侧方腰椎间融合术的手术技术和初步临床结果。[方法] 2017年10月~2019年5月采用导航辅助同一体位侧方腰椎间融合术治疗退变性腰椎滑脱症患者27例。取右侧卧位，首先完成侧方入路椎间盘切除及融合器植入，然后不改变体位，将导航参考架固定于左侧髂嵴，O臂扫描获取手术节段三维图像并传输至导航主机。导航引导下确认背部椎弓根螺钉进钉点，导航实时引导下开路并放置导丝，沿着导丝攻丝、导航引导下置入经皮椎弓根空心螺钉。[结果] 所有患者顺利手术，无严重并发症，所有患者随访3-24个月。末次随访时腰痛、腿痛VAS评分和ODI评分，以及术后滑脱率、椎间隙高度和硬膜囊面积均较术前显著改善(P<0.05)。改良MacNab标准临床效果，优良率100%。（27/27）。27例患者共置入椎弓根螺钉122枚，平均置钉时间(9.22±3.84)min/枚，按照Gertzbein-Robbins分级标准，所有螺钉置钉准确率为93.4%。[结论] 导航辅助同一体位侧方腰椎间融合术可以避免术中更换体位，是一种安全高效的手术方法。
[Objective] To introduce the surgical technique and primary clinical outcomes of navigation assisted Single-position lateral lumbar interbody fusion. [Methods] From October 2017 to May 2019, 27 patients underwent navigation assisted single-position lateral lumbar interbody and fusion for degenerative lumbar spondylolisthesis. The patients were placed in right lateral position by a left lumbar incision. Firstly completed the lateral approach discectomy and cage implantation. Secondly didn’t change the position, the navigation reference fixed on the left side of the illac crest. Obtained surgical segmental three-dimensions images by O-arm and transfer to navigation. The insertion point of the percutaneous pedicle screw was confirmed under navigation guidance. Opened circuit under real-time guidance of navigation and placed the guide wire, tapped along the guide wire. Percutaneous cannulated pedicle screw were inserted by navigation. [Results] All the 27 patients had operation performed smoothly without serious complications. All patients were followed up for 3-24 months. at the latest follow-up the ODI and VAS scores of low back pain and leg pain, as well as postoperative slippage rate, intervertebral space height and cross-sectional of the dural sac were significantly improved postoperatively compared with those preoperatively(P<0.05). The excellent and good rate of clinical results based on the modified MacNab criteria was 100% (27/27). 122 pedicle screws were placed in 27 patients with an average screw placement time of (9.22±3.84) min/screw. The accuracy of all pedicle screws was 93.4% according to the Gertzbein-Robbins classification standard. [Conclusion] The navigation assisted single-position lateral lumbar interbody and fusion is a safe and high-efiicient surgical method that avoids change position intraoperative.