| 沈世彬,高慧珊,黄浩然,等.3D打印导板辅助经皮椎间孔镜下腰椎间盘切除术的临床应用效果.骨科,2023,14(5): 407-412. |
| 3D打印导板辅助经皮椎间孔镜下腰椎间盘切除术的临床应用效果 |
| Clinical Application of 3D Printing Guide Plate Assisted Percutaneous Lumbar Discectomy Under Intervertebral Foramen |
| 投稿时间：2022-11-14 |
| DOI：10.3969/j.issn.1674-8573.2023.05.003 |
| 中文关键词: 3D打印技术 导板 椎间孔镜 腰椎间盘突出症 经皮椎间孔镜下腰椎间盘切除术 |
| 英文关键词: 3D printing technology Guide plate Intervertebral foramen endoscope Lumbar disc herniation Percutaneous endoscopic lumbar discectomy |
| 基金项目:青岛市医药卫生科研指导项目（2022-WJZD237） |
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| 中文摘要: |
| 目的 探讨3D打印导板辅助经皮椎间孔镜下腰椎间盘切除术（PELD）治疗腰椎间盘突出症（LDH）的临床效果。方法 选取2020年8月至2021年8月在我院采用PELD治疗单节段LDH的48例病人，根据是否采用3D打印导板辅助手术分为导板组和对照组。导板组24例，采用3D打印导板辅助下穿刺行PELD治疗，对照组24例，采用单纯PELD治疗。比较两组的手术时间、术中出血量、穿刺次数、穿刺时间、透视次数、住院时间，比较两组在术前及术后不同时间的疼痛视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分、改良MacNab疗效评价和术后并发症发生率。结果 病人随访（9.33±1.24）个月（7~12个月）。导板组病人的手术时间、术中出血量、穿刺次数、穿刺时间、透视次数及住院时间均明显低于对照组，差异有统计学意义（P＜0.05）。两组术后VAS评分均低于术前，差异有统计学意义（P＜0.05）；导板组在术后1天、1周时的VAS评分低于对照组，差异有统计学意义（P＜0.05）；但两组术后1个月、3个月的VAS评分比较，差异无统计学意义（P＞0.05）。两组术后JOA评分均较术前明显升高，差异有统计学意义（P＜0.05）；但组间各时间段的JOA评分比较，差异无统计学意义（P＞0.05）。两组末次随访改良MacNab标准的优良率、并发症发生率比较，差异均无统计学意义（P＞0.05）。结论 通过3D打印导板辅助PELD治疗单节段LDH，手术效果确切，明显提高了穿刺准确性，减少了因反复穿刺而带来的手术创伤及辐射伤害，提高了手术效率、缩短了手术时间，对术后短期内疼痛的缓解作用显著，具有良好的临床使用前景。 |
| 英文摘要: |
| Objective To explore the clinical effect of 3D printing guide plate assisted percutaneous endoscopic lumbar discectomy (PELD) in the treatment of lumbar disc herniation (LDH). Methods A total of 48 patients with single-segment LDH who underwent PELD in our hospital from August 2020 to August 2021 were selected, and divided into experimental group and control group according to whether 3D printing guide plate was used or not. There were 24 cases in experimental group treated with 3D printing guide plate assisted PELD, and cases in control group treated with PELD alone. The operation time, blood loss during operation, puncture times, puncture time, fluoroscopy times, length of stay (LOS), visual analogue scale (VAS) score, Japan Orthopaedic Association (JOA) score, modified MacNab curative effect evaluation standard and postoperative complication rate were compared between the two groups. Results The patients were followed up for (9.33±1.24) months (7-12 months). The operation time, blood loss, puncture times, puncture time, fluoroscopy times and LOS of the patients in the experimental group were significantly reduced as compared with those in the control group (P＜0.05). The VAS score after operation was lower than that before operation in both groups (P＜0.05). The VAS scores in the experimental group at 1st day and 1st week after operation were better than those in the control group (P＜0.05). There was no significant difference in VAS scores between the two groups at 1st month and 3rd month after operation (P＞0.05). The postoperative JOA scores in both groups were significantly higher than those before operation (P＜0.05), but there was no significant difference in JOA scores between the two groups (P＞0.05). There was no significant difference in the evaluation on excellent and good rate of modified MacNab as well as complication rate between the two groups at the last follow-up (P＞0.05). Conclusion 3D printing guide plate assisted PELD is effective in the treatment of single-segment LDH, which obviously improves the puncture accuracy, reduces the surgical trauma and fluoroscopic radiation injury caused by repeated puncture, improves the operation efficiency, shortens the operation time, and has a significant effect on relieving pain in a short time after operation, with a good clinical application prospect. |
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