超声容积导航技术引导椎间孔镜穿刺技术的应用  

Ultrasound volume navigation technology in transforaminal puncture of minimally invasive lumbar surgery with full-endoscopic techniques

作　　者：付强[1] 刘彦斌[1] 李军[1] 蔡郑东[3] 王茵[2] 王红 

机构地区：[1]第二军医大学附属长海医院脊柱外科,上海200433 [2]第二军医大学附属长海医院超声科,上海200433 [3]上海市第一人民医院骨科,200080 [4]GE公司医疗系统应用部,上海200336

出　　处：《中华骨科杂志》2016年第1期1-8,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用超声容积导航技术引导腰椎经皮后外侧入路内镜下椎间孔穿刺的可行性及临床疗效。方法回顾性分析自2011年6月至2013年6月收治的60例行腰椎经皮后外侧入路内镜下手术治疗腰椎间盘突出症患者资料，男37例，女23例；年龄17-64岁，平均32．9岁；全部为单节段、单侧腰椎间盘突出；手术节段L4．，47例，L5s。13例。按抽签方式随机将60例患者分为超声容积导航组（29例，在超声容积导航辅助下行椎间孔穿刺，最终以“C”型臂X线机透视确认穿刺位置）和“C”型臂X线机透视组（31例，在“C”型臂X线机透视下行椎间孔穿刺）。术中统计总穿刺时间及“C”型臂X线机透视次数。随访采用视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI）评定临床疗效。结果所有手术操作均顺利完成，无严重并发症发生。术中超声容积导航组术前超声校准时间为11N16min，平均（13．7±2．1）rain，穿刺全过程用时16-28min，平均（20．6±3．1）min；“C”型臂X线机透视组穿刺全过程用时25-32min，平均（27．9±1．7）min，差异有统计学意义。超声容积导航组“C”型臂X线机透视次数4-7次，平均（4．9±0．8）次，“C”型臂X线机透视组透视次数13-17次，平均（14．3±1．2）次，差异有统计学意义。60例穿刺准确率100％，穿刺针最终均能到达目标区域。随访时间12-26个月，平均16．4个月。超声容积导航组ODI指数，术前72．9％±5．9％、术后3个月17．1％±3．6％、术后1年15．9％±3．3％，与“C”型臂X线机透视组术前73．2％±4．9％、术后3个月17．3％±3．3％、术后1年16．1％±2．9％相比，差异均无统计学意义。超声容积导航组VAS评分术前（7．4±0．9）分、术后3个月（2．2±0．7）分、术后1年（1．9±0．8）分和“C”型臂X线机透视组术前（Objective To evaluate the effectiveness of ultrasound （US） volume navigation technology in guiding the lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach. Methods From June 2011 to June 2013, 60 patients （37 males and 23 females; mean age： 32.9 years） with single-level lumbar disc herniation who had undergone lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach were enrolled in this retrospective study, and they were randomly divided into 2 groups according to whether the assistance of ultrasound volume navigation technology was used. They received the minimally invasive surgery on L4,5 （47 cases） and LSI （13 cases）. In the US-guidance group （29 cases）, ultrasound volume navigation was used to guide puncture process, and in the C-arm guided group （31 cases）, C-arm was applied to guide the puncture process The total puncture time and C-arm fluoroscopy times were recorded. Parameters including Oswestry disability index （ODI） and visual analogue scale （VAS） were selected to evaluate the clinical efficacy. Results Patients had no obvious discomfort during the puncture procedure and no postoperative complications. In US-guidance group, the preoperative time was 13.7 ±2.1 min （range, 11-16 min）, and the whole process took 20.6±3.1 min （range, 16-28 min）, while the average time of C-arm exposure were 4.9±0.8 times （range, 4-7 times）. In C-arm guided group, the average time for puncture procedure was 27.9±1.7 min （range, 25-32 min）, and the average times of C-arm exposure were 14.3±1.2 times （range, 13-17 times）. There were significant differences between two groups. Compared with C-arm guided group, US-guidance group had the same accuracy rate of puncture （the puncture needles all reached the target area）, but the fluoroscopy times and puncture timewere decreased sig- nificantly. There＇ s no significant difference among the pre and postoperative ODI and VAS indexes. Patient

关 键 词：超声检查 外科手术 计算机辅助 内窥镜 

分 类 号：R687.3[医药卫生—骨科学]