C型臂X线导航在经皮腰椎间孔镜椎间盘摘 除术穿刺定位中的应用效果  

Application effect of C-arm X-ray navigation in needle localization during percutaneous endoscopic lumbar discectomy

作　　者：秦豪[1] 杨克勤[1] 江建中[1] 黄圣斌[1] 谢兆林[1] 罗翔[1] 傅山泓 谭海涛[1] QIN Hao;YANG Ke-qin;JIANG Jian-zhong;HUANG Sheng-bin;XIE Zhao-lin;LUO Xiang;FU Shan-hong;TAN Hai-tao(Department of Orthopaedics,Guigang City People′s Hospital,Guigang 537100,China;Guangzhou Xiongjun Intelligent Technology Co.,Ltd.,Guangzhou 511447,China)

机构地区：[1]广西贵港市人民医院骨科,贵港市537100 [2]广东省广州雄俊智能科技有限公司,广州市511447

出　　处：《广西医学》2020年第19期2478-2482,共5页Guangxi Medical Journal

基　　金：广西自然科学基金(2018GXNSFAA294129);广西科技计划(桂科AD17129017,桂科17195042);广西贵港市科学研究与技术开发计划(贵科通1834002,贵科转1803002)。

摘　　要：目的探讨C型臂X线导航在经皮腰椎间孔镜椎间盘摘除术(PELD)穿刺定位中的应用效果。方法根据传统Joimax椎间孔镜穿刺针的特点,采用3D打印技术研制可与计算机导航系统连接的PELD一级穿刺导杆。选取成人解剖遗体标本8具,采用传统定位方法和C型臂X线导航定位方法,分别穿刺L 3~4、L 4~5及L 5~S 1腰椎节段两侧椎间孔。比较两种方法在每个穿刺点的透视和穿刺次数、透视和穿刺时间、总穿刺定位时间,记录两种方法的学习曲线。结果C型臂X线导航定位方法学习曲线较传统定位方法低平,总穿刺定位时间随穿刺次数增加呈明显减少趋势。C型臂X线导航定位方法的透视和穿刺次数、透视和穿刺时间、总穿刺定位时间均少于传统定位方法(均P<0.05)。结论C型臂X线导航辅助PELD穿刺定位,可降低初学医生的学习曲线,减少PELD总穿刺定位时间,并可通过减少透视和穿刺次数、穿刺时间,降低PELD术中患者与医务人员的X线辐射量。Objective To investigate the application effect of C-arm X-ray navigation in needle localization during percutaneous endoscopic lumbar discectomy(PELD).Methods According to the characteristics of the traditional Joimax transforaminal needle,a PELD primary puncture guide rod connected with the computer navigation system was developed using 3D printing technology.Eight adult cadaveric specimens were selected,and the bilateral lumbar foramina on L 3-4,L 4-5,and L 5 to S 1 lumbar segments were punctured separately using the traditional positioning method and the C-arm X-ray navigation positioning method.Number of fluoroscopy/puncture,duration of fluoroscopy/puncture,and total duration of needle localization for each puncture site were compared between the two methods,the learning curves of the two methods were recorded.Results The C-arm X-ray navigation positioning method had a flat learning curve than the traditional positioning method,exhibiting a total duration of needle localization to decrease significantly with the increasing number of puncture.The C-arm X-ray navigation positioning method achieved decreased number of fluoroscopy/puncture,less duration of fluoroscopy/puncture,and less total duration of needle localization than the traditional positioning method(all P<0.05).Conclusion C-arm X-ray navigation-assisted PELD for needle localization can reduce the learning curve of novice doctors,and decrease the total duration of needle localization in PELD;in addition,it can reduce the X-ray radiation dose of patients and medical staff during PELD procedure by diminishing number of fluoroscopy/puncture and duration of puncture.

关 键 词：C型臂X线导航 穿刺定位 3D打印 经皮腰椎间孔镜 椎间盘摘除术 学习曲线 辐射 

分 类 号：R681.5[医药卫生—骨科学] R323.4[医药卫生—外科学]