导航辅助脊柱内镜经椎间孔入路穿刺和椎间孔成形的临床研究  

Clinical Study of Spinal Endoscopic System Puncture and Foraminoplasty via Intervertebral Foramen with Navigation System

作　　者：王少纯 陈波涛 Wang Shaochun;Chen Botao(Department of Spinal Surgery,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Luoyang 471002,China;Department of Orthopaedics,Affiliated Hospital of Chengdu University of Chinese Medicine,Chengdu 610075,China)

机构地区：[1]河南省洛阳正骨医院,河南省骨科医院脊柱外科,河南洛阳471002 [2]成都中医药大学附属医院骨科,四川成都610075

出　　处：《实用骨科杂志》2020年第5期385-389,共5页Journal of Practical Orthopaedics

摘　　要：目的观察电磁导航辅助下脊柱内镜系统经椎间孔入路穿刺及椎间孔成形的临床应用价值。方法本研究为前瞻性队列研究。选取河南洛阳正骨医院脊柱外科2018年4月至2019年4月诊断为腰椎间盘突出症伴侧隐窝狭窄的患者60例,采用随机数字表法分为两组。观察组30例接受电磁导航辅助下经椎间孔入路内窥镜脊柱系统(transforaminal endoscopic spine system,TESSYS)行椎间孔成形,其中男18例,女12例;年龄(40.73±5.90)岁。对照组30例采用标准TESSYS技术行椎间孔成形,其中男19例,女11例;年龄(42.67±6.40)岁。两组患者性别、年龄、身体质量指数(body mass index,BMI)、术前视觉模拟评分(visual analogue scale,VAS)及病变节段差异无统计学意义(P>0.05)。记录两组术中定位穿刺时间、关节突成形时间、手术时间、透视次数、与穿刺和椎间孔成形相关的并发症、改良MacNab评分并进行比较。结果观察组透视次数、定位穿刺时间、关节突成形时间及手术时间低于对照组,差异有统计学意义(P<0.05)。改良MacNab评分两组比较差异无统计学意义(P>0.05)。术中并发症发生率观察组为6.7%(2/30),对照组为16.7%(5/30),两组比较差异无统计学意义(P>0.05)。结论电磁导航辅助下进行腰椎内镜TESSYS技术操作,有利于精准穿刺定位和椎间孔成形,能够有效减少术中透视次数,降低医患辐射暴露剂量,缩短手术时间,降低青年医师的学习曲线。Objective To observe the clinical value of transforaminal puncture and transforaminal plasty(TESSYS)of spine endoscopy system assisted by electromagnetic navigation.Methods This was a prospective cohort study.From April 2018 to April 2019,60 patients with lumbar disc herniation accompanied by lateral recess stenosis from Henan provincial orthopedic hospitalspinal surgery department,were selected and randomly divided into two groups.30 patients in the observation group were treated with TESSYS technique assisted by electromagnetic navigation and 30 patients in the control group were treated with standard TESSYS technique.There was no significant difference in gender,age,BMI and lesion segment between the two groups(P>0.05).The time of intraoperative puncture,arthroplasty,operation,and fluoroscopy,the complications related to puncture and foramen formation,and the modified MacNab score were recorded and compared between the two groups.Results The times of fluoroscopy,puncture,arthroplasty and operation in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the modified MacNab score(P>0.05).The incidence of intraoperative complications was 6.7%(2/30)in the observation group and 16.7%(5/30)in the control group,the difference was not statistically significant(P>0.05).Conclusion The operation of TESSYS under the assistance of electromagnetic navigation is helpful to the precise location of puncture and the foraminoplasty.It can effectively reduce the times of intraoperative fluoroscopy and the radiation exposure dose of doctors and patients,shorten the operation time,and reduce the learning curve of TESSYS.

关 键 词：腰椎 椎间盘 椎间孔成形 椎间盘切除术 导航 

分 类 号：R681.53[医药卫生—骨科学]