| 刘扬,赵红卫,刘文俊,等.三种环锯法在脊柱内镜下腰椎融合术关节突切除中的应用对比.骨科,2025,16(6): 494-499. |
| 三种环锯法在脊柱内镜下腰椎融合术关节突切除中的应用对比 |
| Comparison of three circular sawing methods for facet joint resection in lumbar fusion surgery under spinal endoscopy |
| 投稿时间：2025-04-27 |
| DOI：10.3969/j.issn.1674-8573.2025.06.003 |
| 中文关键词: 脊柱内镜 腰椎融合术 环锯法 关节突切除术 微创手术 |
| 英文关键词: Spinal endoscopy Lumbar interbody fusion Annular trephination Facetectomy Minimally invasive surgery |
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| 中文摘要: |
| 目的 比较全透视、半透视及全直视环锯法在脊柱内镜下腰椎融合术关节突切除中的临床应用效果。方法 回顾性分析2022年1月至2024年12月于我院行内镜下腰椎融合手术的132例单节段单侧腰椎管狭窄合并（或不合并）腰椎滑脱病人的临床资料，分为全透视组（35例）、半透视组（58例）和全直视组（39例）。对比三组病人的手术参数（减压时间、透视次数）、临床疗效[疼痛视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分、改良MacNab评分]及并发症发生情况。结果 全透视组术中透视次数最多[（6.1±1.2）次]，全直视组透视次数最少[（1.3±1.1）次]；半透视组减压时间最短[（69.8±9.8） min]，全直视组最长[（83.6±15.3） min]。三组病人术后1周VAS评分较术前均明显下降，术后1个月JOA评分较术前明显上升，组内比较差异有统计学意义（P＜0.05），但组间比较，差异均无统计学意义（P＞0.05）。全直视组、半透视组、全透视组术后1个月的改良MacNab优良率分别为94.9%、98.3%、100%，差异无统计学意义（P＞0.05）；硬脊膜损伤发生率分别为2.6%、1.7%和0，并发症发生率均处于脊柱微创手术的安全阈值范围内。结论 在脊柱内镜下腰椎融合术关节突切除的操作中，全透视技术通过实时深度监测提高病例的精准性；半透视技术平衡了辐射暴露与初始定位精度；全直视技术则通过减少透视次数降低辐射暴露，但手术时间较长。手术医生可根据病人骨性结构特征（如关节突增生程度、椎间孔形态）及操作习惯进行个性化选择。 |
| 英文摘要: |
| Objective To compare the clinical application effects of full perspective, semi perspective, and full view circular sawing methods in the joint process resection of lumbar fusion surgery under spinal endoscopy. Methods A retrospective analysis was conducted on the clinical data of 132 patients with single segment unilateral lumbar spinal stenosis with (or without) lumbar spondylolisthesis who underwent endoscopic lumbar fusion surgery from January 2022 to December 2024 in our hospital. The patients were randomly divided into full perspective group (35 cases), semi perspective group (58 cases), and full view group (39 cases). The surgical parameters (decompression time, fluoroscopy frequency), clinical efficacy [vision analogue acale (VAS) score, Japanese Orthopedic Association (JOA) score, modified MacNab score], and incidence of complications among three groups of patients were compared. Results The full perspective group had the greatest number of fluoroscopy sessions [(6.1±1.2) times], while the total view group had the fewest [(1.3±1.1) times]; The semi perspective group had the shortest decompression time [(69.8±9.8) min], while the full view group had the longest [(83.6±15.3) min]. The VAS scores of the three groups decreased significantly 1 week after surgery compared to those before surgery, and the JOA scores increased significantly 1 month after surgery compared to those before surgery, with statistically significant differences (P＜0.05), but there was no statistically significant difference among the groups (P＞0.05). The MacNab efficacy evaluation at 1 month after surgery was 94.9% in the full view group, 98.3% in the semi perspective group, and 100% in the full perspective group (P＞0.05). The incidence of spinal cord injury was 2.6% in the full view group, 1.7% in the semi perspective group, and 0 in the full perspective group. However, the incidence of complications in all groups was within the safe threshold for minimally invasive spinal surgery. Conclusion Full perspective technology improves the accuracy of cases through real-time deep monitoring; Semi perspective technology balances radiation exposure and initial positioning accuracy; Full view technology reduces radiation exposure by reducing the number of fluoroscopy sessions, but the surgical time is longer. Surgical doctors can make personalized choices based on the patient's bone structure characteristics (such as degree of articular process hyperplasia, intervertebral foramen morphology) and operating habits. |
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