文章摘要
巩陈,吴建明,张文志,等.自制辅助穿刺装置联合三维可视化技术在内窥镜下经椎间孔腰椎间盘切除术中的应用.骨科,2023,14(5): 401-406.
自制辅助穿刺装置联合三维可视化技术在内窥镜下经椎间孔腰椎间盘切除术中的应用
Application of Self-Made Auxiliary Puncture Device Combined with Three-Dimensional Visualization Technology in Endoscopic Transforaminal Lumbar Discectomy
投稿时间:2023-05-13  
DOI:10.3969/j.issn.1674-8573.2023.05.002
中文关键词: 内镜下椎间盘切除术  微创手术  经椎间孔减压  腰椎间盘突出症  穿刺  腰椎
英文关键词: Endoscopic discectomy  Minimally invasive surgery  Transforaminal decompression  Lumbar disc herniation  Puncture  Lumbar vertebra
基金项目:安徽省重点研究与开发计划项目(202104j07020053);亳州市人民医院三新项目(2021ZDA-01)
作者单位E-mail
巩陈 安徽医科大学附属亳州医院脊柱外科安徽亳州 236800  
吴建明 安徽医科大学附属亳州医院脊柱外科安徽亳州 236800 ahbzwjmfcy@163.com 
张文志 中国科学技术大学附属第一医院脊柱外科合肥 230036  
刘向阳 安徽医科大学附属亳州医院脊柱外科安徽亳州 236800  
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中文摘要:
      目的 探讨自制辅助穿刺装置联合三维可视化技术在经皮内窥镜下经椎间孔腰椎间盘切除术(PETD)治疗腰椎间盘突出症(LDH)中的应用效果。方法 2021年1月至2022年5月,安徽医科大学附属亳州医院脊柱外科94例LDH病人接受PETD治疗,采用随机数字表法选择通道建立方法。46例采用自制辅助穿刺装置联合三维可视化技术建立通道(研究组),48例采用传统穿刺法建立通道(对照组),两组通道建立后采用经皮椎间孔镜(TESSYS)技术完成椎间盘切除和神经根减压。分析两组透视次数、穿刺次数、穿刺时间、一次穿刺成功数、住院天数、手术时间及末次随访时改良MacNab标准评价结果。结果 所有病人都顺利完成手术和随访,无严重并发症发生。研究组和对照组的随访时间分别为(8.9±2.1)个月、(8.7±1.8)个月,两组差异无统计学意义(t=0.622,P=0.109)。研究组的穿刺时间少于对照组[(14.1±4.3) min vs. (19.1±3.7) min],穿刺次数少于对照组[(3.8±2.1)次 vs. (7.9±2.6)次],透视次数少于对照组[(8.3±3.3)次 vs. (15.1±4.2)次],手术时间少于对照组[(79.0±8.5) min vs. (89.7±13.4) min],一次穿刺成功数多于对照组(12例 vs. 4例),组间比较,差异均有统计学意义(P<0.05)。两组住院天数以及末次随访时的优良率比较,差异无统计学意义(P>0.05)。结论 采用自制辅助穿刺装置联合三维可视化技术建立通道可以明显减少穿刺次数、透视次数、穿刺时间和手术时间,一次穿刺成功率较高,手术安全且疗效满意,这种新的通道建立方法是可行的。
英文摘要:
      Objective To study the application effect of self-made auxiliary puncture device combined with three-dimensional visualization technology in the treatment of lumbar disc herniation (LDH) by percutaneous endoscopic transforaminal lumbar discectomy (PETD). Methods From January 2021 to May 2022, 94 LDH patients in the First Affiliated Hospital of China University of Science and Technology received PETD, and the channel establishment method was selected by a random number table method. The self-made auxiliary puncture device combined with three-dimensional visualization technology was established in 46 cases (experimental group), and the traditional puncture method was used in 48 cases (control group). After the channel was established, transforaminal endoscopic spine system (TESSYS) technology was used to complete discectomy and nerve root decompression in both groups. The fluoroscopy times, puncture times, puncture time, number of first puncture success, hospitalization days, operation time and modified MacNab criteria at the last follow-up were analyzed between the two groups. Results All patients successfully completed the operation and follow-up, and no serious complications occurred. The follow-up time for the experimental group and control group was (8.9±2.1) months and (8.7±1.8) months, respectively, with no statistically significant difference between the two groups (t=0.622, P=0.109). Puncture time in the experimental group was shorter than that in the control group [(14.1±4.3) min vs. (19.1±3.7) min]. Puncture times in the experimental group were less than those in the control group [(3.8±2.1) times vs. (7.9±2.6) times]. Fluoroscopy times in the experimental group were less than those in the control group [(8.3±3.3) times vs. (15.1±4.2) times]. Operation time in the experimental group was shorter than that in the control group [(79.0±8.5) min vs. (89.7±13.4) min]. The number of first puncture success in the experimental group was greater than that in the control group (12 cases vs. 4 cases) with the differences being statistically significant (P<0.05). There were no significant differences in the length of hospital stay and the excellent and good rate between the two groups at the last follow-up (P>0.05). Conclusion The use of self-made auxiliary puncture device combined with three-dimensional visualization technology to establish a channel can significantly reduce puncture times, fluoroscopy times, puncture time and operation time. The one-time puncture success rate is high, the operation is safe and satisfactory. This new channel establishment method is feasible.
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