| Background:At the present stage,our country is gradually entering the aging society,and with the changes of modern lifestyle,the lumbar degenerative diseases even begins to appear a trend of getting younger.The relatively high prevalence rate and incidence rate of these diseases seriously affect the mental and physical health and quality of work and life of Chinese people,and brings a heavy economic and spiritual burden to many families.In the early stage of disease development,conservative treatment can often achieve good curative effect,but conservative treatment does not fundamentally solve the pathological factors.With the progress of the disease,surgery is often needed to completely solve the pathological factors on the nerve root and dural sac compression.The traditional open lumbar surgery requires extensive stripping and pulling of the paravertebral muscle during the operation,which is easy to cause related complications after operation.With the continuous development of percutaneous spinal endoscopy and minimally invasive instruments,Endoscopic interbody fusion(Endo-LIF),assisted by percutaneous endoscopy,is being continuously developed and applied in clinical practice,and has achieved good clinical effect.At present,the mainstream endoscopic fusion technology is mainly single-channel endoscopy,but its endoscopic instruments and endoscopes are coaxial,and its field of vision and instrument operation are limited.When unilateral approach and bilateral decompression are required for severe spinal stenosis,there are certain limitations and difficulties.In this situation,Biportal Endoscopy spine surgery(BESS),in which the working passage is separated from the endoscopic passage,is now back on the horizon of spine surgeons.BESS technology has shown unique advantages in terms of surgical vision and operational flexibility.However,in the process of clinical practice,our research team found the potential technical difficulties and deficiencies of this technology.Therefore,we improved the traditional BESS technology,innovatively designed and developed A puncture guide bar with a magnetic field at the tip,a kind of fascial tube made of polymer plastic material and a set of special BESS surgical instruments,so that this technology can better play its advantages.At present,there is less clinical evidence in China about Biportal endoscopic lumbar interbody fusion(BE LIF),and more clinical studies are needed to demonstrate the advantages and disadvantages of its minimally invasive operation.In addition,with the continuous development of digital navigation technology,there is no domestic research report on BE-LIF assisted by total navigation.This study will further introduce the application of digital total navigation technology in the treatment of lumbar degenerative diseases with BE-LIF,and explore its advantages and disadvantages.Part one:Technical improvement of biportal endoscopy spine surgeryObjective: To improve the traditional BESS technique and design corresponding auxiliary tools and special surgical instruments,so as to maintain a clear visual field as far as possible,protect the paravertebral soft tissues,reduce the risk of spinal cord nerve injury,and make the operating instruments more suitable for endoscopic operationMethods: Under the support of the 13 th Five-Year Plan project of the Ministry of Science and Technology,"biportal endoscopic spinal endoscopy"(2019YFC0121400),our research team cooperated with Qingdao Yuren Technology Co.,Ltd.to complete the corresponding product design,production and processing.Results: Completed the production of a puncture guide bar with a magnetic field at the tip,fascial tubes and special surgical instruments for BESS and applied them to clinical practice,and obtained the record of Class I medical instruments of the Food and Drug Administration(record No.: Luqing Instrument No.20200955).Conclusion: Based on the potential shortcomings of traditional BESS technology,our research group improved the technology,innovatively developed and designed corresponding auxiliary tools and special surgical instruments,so as to facilitate BESS surgeons to complete the surgery more safely,comfortably and efficiently.Part two: Clinical evaluation of biportal endoscopic lumbar interbody fusion in the treatment of degenerative lumbar diseases.Objective: To investigate the clinical efficacy and advantages of Biportal Endoscopic Lumbar Interbody Fusion(BE-LIF)in the treatment of Lumbar degenerative diseases and provide a reference for the selection of minimally invasive surgery for lumbar degenerative diseases.Methods: The clinical data of 62 patients with lumbar degenerative diseases admitted to our hospital from October 2020 to June 2021 were retrospectively analyzed,including 30 cases in the BE-LIF group and 32 cases in the MIS-TLIF group.The preoperative demographic data of the two groups were recorded,including age,gender,body mass index(BMI),preoperative diagnosis,and surgical segment.Perioperative data included operative time,intraoperative blood loss,postoperative drainage,postoperative hospital stay,and complications.The clinical efficacy was evaluated by visual analogue scale(VAS)score of low back pain and leg pain,Oswestry Disability Index(ODI)score,excellent and good rate of modified Mac Nab score and interbody fusion rate..Results: All patients were followed up for more than 12 months.The operation time of BE-LIF group(171.56±13.11 min)was longer than that of MIS-LIF group(138.71±12.57min)(P < 0.001),and the average estimated blood loss and postoperative drainage volume of BE-LIF group(87.33±17.10 ml,73.83±15.84ml)was significantly lower than that in MIS-TLIF group(129.62±32.85 ml,P < 0.001;101;56±15.88 ml,P < 0.001).Compared with MIS-TLIF group,postoperative hospital stay of BE-LIF group was significantly shorter(4.93±1.22 d vs 6.13±0.98,P < 0.001).The VAS and ODI scores of low back pain and leg pain in the two groups were significantly improved with time compared with those before operation.There was no significant difference in VAS and ODI scores of leg pain at 3 days after operation,low back pain and leg pain at 3 months after operation and at the 1 year follow-up between the two groups(P > 0.05).However,the VAS score of low back pain was improved more significantly in BE-LIF group than in MIS-TLIF group three days after operation(P < 0.001).The fusion rate of BE-LIF group was 96.6%,and that of MIS-LIF group was 93.8%,there was no significant difference between the two groups(P > 0.05).According to the modified Mac Nab criteria,the excellent and good rates of BE-LIF group and MIS-TLIF group at the last follow-up were 93.3% and 90.6%,and there was no significant difference between the two groups(P > 0.05).Conclusion: Compared with MIS-TLIF,BE-LIF not only has similar short and medium-term clinical results and fusion rate,but also has the advantages of less intraoperative bleeding,less early postoperative low back pain,and faster postoperative recovery,which provides a new option for minimally invasive endoscopic treatment of lumbar degenerative diseases.Part three: Clinical application of total navigation assisted biportal endoscopic lumbar interbody fusionObject: The clinical efficacy,radiation dose,operative time and other relevant data of BE-LIF assisted by total navigation and traditional fluoroscopy were retrospectively analyzed.To Evaluate the feasibility,safety and effectiveness of the technique and explore the advantages and disadvantages of total navigation technology in BE-LIF.Methods: A total of 44 patients were retrospectively analyzed from August 2020 to June2021.Perioperative data were collected,including operative time,estimated intraoperative blood loss,postoperative drainage,postoperative hospital stay,radiation dose,and duration of radiation exposure.In addition,clinical outcomes were evaluated using postoperative data,such as the Oswestry Disability Index(ODI),visual analog scale(VAS),modified Mac Nab criteria,Postoperative complications and fusion rate,and the BE-LIF technology under the total navigation was demonstrated,from skin incision location design to endoscopic decompression and fusion,to percutaneous pedicle screw placement.Results: All patients were successfully operated and followed up for more than 12 months.Clinical outcomes(VAS and ODI scores and Mac Nab criteria)were not significantly different between the two groups.There were no significant differences in age,gender,BMI,preoperative diagnosis and surgical segment between navigation group and non-navigation group(P > 0.05).The radiation dose of navigation BE-LIF group was 3.18± 1.02 m Gy,which was significantly lower than that of perspective BE-LIF group(14.38± 3.26 m Gy)(p <0.001).The radiation exposure time of navigation BE-LIF group was 6.90±2.30 s,and that of perspective BE-LIF group was 31.55±5.88 s(p <0.001).There were no significant differences in intraoperative assessed blood loss,postoperative drainage volume,postoperative hospital stay,and perioperative complications between the two groups.The mean total operative time in the navigational BE-LIF group was significantly shorter than that in the fluoroscopy BE-LIF group(154.04±11.17 min)(170.91±12.01,p <0.001);There was no significant difference in VAS score and ODI between the two groups at baseline.Compared with preoperative score,VAS score and ODI in 2 groups were significantly improved at different time points after surgery.However,there was no significant difference between the two groups when compared at the same point in time.According to the evaluation criteria for the efficacy of modified Macnab,there was no statistical difference in the rate of good and good between the two groups(p =0.418).At the one-year follow-up after surgery,the spinal fusion rate of the fluoroscopy BE-LIF group was 82.60%(19 cases),and that of the navigation BE-LIF group was 85.71%(18 cases),showing no statistical difference between the two groups.No serious complications occurred in the two groups.Conclusion: Compared with the non-navigation approach,total navigation assistive BE-LIF technology not only has similar clinical results,but also can provide accurate intraoperative guidance and help spinal surgeons achieve accurate decompression.Furthermore,it can reduce radiation exposure to surgeons and operation time,which improve the efficiency and safety of surgery.However,the high radiation exposure to patients and the prevention of intraoperative navigation image distortion are the problems to be faced and solved by this technology in the future. |
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