目的：通过对比术中三维 CT 导航辅助下微创经椎间孔腰椎椎体间融合术( minimally invasive transforaminal lumbar interbody fusion with intraoperative computed tomography，iCT-MIS-TLIF )、单纯微创经椎间孔腰椎椎体间融合术( minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF )与传统开放经椎间孔腰椎椎体间融合术( conventional open transforaminal lumbar interbody fusion，COTLIF )治疗单节段腰椎退行性疾病的临床效果差异，探讨术中三维 CT 导航辅助下 MIS-TLIF 的可行性。方法2009年4月至2011年9月，我院收治45例单节段腰椎间盘突出患者，根据患者自己的治疗意愿及术前资料的综合分析，11例采用 iCT-MIS-TLIF 进行治疗，15例采用 MIS-TLIF 进行治疗，19例采用 COTLIF 进行治疗。比较三组患者在手术时间、术中出血量、术后引流量、术后平均住院日和术后下床时间的差异，统计术前、术后3天、1.5个月、3个月、6个月、12个月、24个月 Oswestry 功能障碍指数( oswestry disability index，ODI )，疼痛视觉模拟评分( visual analogue scale，VAS )和 X 线评价治疗效果。同时，考虑到术中三维 CT 导航对手术时间的影响，单独记录了术中三维 CT 导航扫描、注册等所需时间。结果术后平均随访24个月，三组患者术前一般资料、VAS 和 ODI 评分差异无统计学意义。术后45例均未出现手术相关并发症。iCT-MIS-TLIF 组手术时间显著高于 MIS-TLIF 组和 COTLIF 组，差异有统计学意义(P＜0.05)；iCT-MIS-TLIF 组和 MIS-TLIF 组术中平均出血量、术后平均引流量、术后平均住院日、术后下床时间差异无统计学意义(P＞0.05)，且均明显低于 COTLIF 组(P＜0.05)。三组 VAS 和 ODI 评分的随访结果与术前相比均有显著改善，但 iCT-MIS-TLIF 组和 MIS-TLIF 组术后3天腰痛 VAS 评分、术后1.5个月 ODI 评分显著低于 COTLIF 组，其余时间点三组之间评分差异无统计学意义，且 iCT-MIS-TLIF 和 MIS-TLIF 组间术后各时间点 VAS 和 ODI 评分差异无统计学意义。术后 X 线评价融合率，三组差异无统计学意义。单独记录的术中三维 CT 导航自动图像注册平均时间为45.5 s，CT 扫描平均时间为9 s，各患者平均进行3.1次的 CT 扫描。由于术中三维 CT 导航导致的手术暂停时间平均为5.8 min。结论 iCT-MIS-TLIF 组和 MIS-TLIF 组均可获得和传统 COTLIF 组相当的治疗效果，但相较于传统 COTLIF 组，两组对患者的损伤程度更小，且术后短期腰背痛程度较低。iCT-MIS-TLIF 和 MIS-TLIF 组间相关指标差异无统计学意义，虽然术中三维 CT 导航会增加患者的放射线暴露剂量，但在解剖结构复杂的患者中，术中三维 CT 导航的辅助显示出其实时性与精确性的特点，有利于螺钉的安全置入。“,”Objective To compare clinical outcomes of the minimally invasive transforaminal lumbar interbody fusion ( MIS-TLIF ) with intraoperative computed tomography ( iCT ) navigation system, minimally invasive transforaminal lumbar interbody fusion ( MIS-TLIF ) and conventional open transforaminal lumbar interbody fusion ( COTLIF ) for single-level lumbar fusion surgery, by which to evaluate clinical effects and feasibility of the MIS-TLIF by assistance of iCT navigation system.Methods From April, 2009 to September, 2011, 45 patients diagnosed as lumbar disc herniation ( LDH ) were treated by one team of surgeons at a single institution. Minimally invasive transforaminal lumbar interbody fusion with intraoperative computed tomography ( iCT-MIS-TLIF )was conducted in 11 cases. MIS-TLIF was conducted in 15 cases. COTLIF was conducted in 19 cases. Patient’s condition was considered and the treatment was voluntarily chosen by patients. Detailed procedures, preoperative and intraoperative images were illustrated. Operation time, intraoperative blood loss, postoperative blood loss ( drain ), mean hospital stay and postoperative ambulation period in 3 groups were compared. Oswestry disability index ( ODI ), visual analogue scale ( VAS ) and X-ray 3 days, 1.5, 3, 6, 12, 24 months postoperatively were applied to evaluate clinical effects. Considering the influence of CT guidance on the operation time, the time cost in scanning and registration were recorded.Results The mean follow-up period was 24 months. There were no signiifcant differences in routine clinical data, VAS and ODI. No complications occurred in all 45 patients. The operation time in iCT-MIS-TLIF group was signiifcantly higher than MIS-TLIF group and COTLIF group (P0.05 ) in iCT-MIS-TLIF group and MIS-TLIF group, which were signiifcantly lower than COTLIF group (P<0.05 ). VAS and ODI results in the follow-up were signiifcantly improved postoperatively in 3 groups. VAS results of iCT-MIS-TLIF group and MIS-TLIF group 3days postoperatively and ODI results postoperatively were signiifcantly lower than COTLIF group. There were no signiifcant differences at other time points. No signiifcant VAS or ODI differences existed in iCT-MIS-TLIF group and MIS-TLIF group at different time points. There were no signiifcant differences in the evaluation of fusion rate by X-ray. The mean automatic image registration time was 45.5 seconds, the mean CT scanning time was 9 seconds, the mean time-out for intraoperative scanning was 5.8 minutes, and the mean total number of CT scans per patient was 3.1 times.Conclusions Minimally invasive approach causes less change in multiifdus, less postoperative back pain and functional disability than conventional open approach. Preliminary experience with the ifrst 11 patients conifrms the feasibility of iCT scanning and integrated navigation system in the minimally invasive lumbar instrumentation. iCT-MIS-TLIF and MIS-TLIF have similar good long-term clinical outcomes and high fusion rates compared with COTLIF with the additional beneifts of less early postoperative back pain and functional disability, early rehabilitation, and shorter hospitalization. No signiifcant differences exist in iCT-MIS-TLIF and MIS-TLIF although with radiation exposure. However, for complicated anatomical structure, iCT navigation system provides better accuracy and safety for posterior spinal instrumentation.