可视环锯在经椎间孔镜术中的有效性和安全性  

Effectiveness and safety of visualized trephine used in transforaminal endoscopy

作　　者：宋偲茂[1] 熊小明[1] 万趸[1] 邓轩赓[1] 石华刚[1] 顾韬 侯伟[1] 孙育良 SONG Si-mao;XIONG Xiao-ming;WAN Dun;DENG Xuan-geng;SHI Hua-gang;GU Tao;HOU Wei;SUN Yu-liang(Department of Spine Surgery,Sichuan Orthopedic Hospital,Chengdu610041,China)

机构地区：[1]四川省骨科医院脊柱外科,四川成都610041

出　　处：《中国矫形外科杂志》2021年第1期18-22,共5页Orthopedic Journal of China

摘　　要：[目的]探讨可视镜外环锯在经皮内镜椎间孔入路手术中应用的安全性及有效性。[方法]2017年6月~2018年6月共58例患者接受经椎间孔镜手术,随机分为两组,其中,29例采用可视环锯技术,29例采用常规TESSYS技术,比较两组患者围手术期与随访资料。[结果]所有患者均顺利完成手术,术中无血管、内脏损伤。术中二次椎间孔成形,可视组4例(13.79%),常规组12例(41.38%),两组间差异有统计学意义(P<0.05)。其他不良事件比较,可视组有2例髓核残留,常规组有4例神经损伤,1例骨块残留,两组差异无统计学意义(P>0.05)。可视组手术时间、关节突成形时间及透视次数均优于常规组(P<0.05)。术中出血量、住院时间两组差异无统计学意义(P>0.05)。两组术后随访5~18个月,平均(14.56±5.62)个月,可视组和常规组分别有2例和1例复发,差异无统计学意义(P>0.05)。随时间推移,两组患者VAS和ODI评分均显著下降(P<0.05),而JOA评分显著增加(P<0.05);各相应时间点,两组间VAS、ODI和JOA评分的差异均无统计学意义(P>0.05)。末次随访时依据MacNab疗效标准,临床结果优良率,可视组为89.66%,常规组为86.21%,两组间差异无统计学意义(P>0.05)。[结论]可视镜外环锯在经椎间孔内镜术中应用具有简化操作、减少射线暴露、提高椎间孔成形准确性的优点,是一项有效安全的技术手段及工具。[Objective]To evaluate the effectiveness and safety of visualized trephine used in percutaneous transforaminal endoscopy.[Methods]From June 2017 to June 2018,58 patients who were undergoing percutaneous transforaminal endoscopy were divided into two groups randomly and equally.Of them,29 patients received operation with the visualized trephine(VT group),while the remaining 29 patients underwent operation with conventional Transforaminal Endoscopic Spine System(TESSYS)technique(conventional group).The perioperative and follow-up documents were compared between the two groups.[Results]All the patients in both groups had operations performed smoothly without injury to blood vessels and abdominal organs.During operation,foraminoplasty for second time happened in 4 patients(13.79%)of the VT group,whereas 12 patients(41.38%)of the conventional group,which was of statistical significance(P<0.05),despite of the fact that no statistical differences in other adverse events in operation were noticed between the two groups(P>0.05).The VT group proved significantly superior to the conventional group regarding the time elapsed for foraminoplasty and frequency of fluoroscopy(P<0.05).The patients were followed up for 5 to 18 months with a mean of(14.56±5.62)months.As time went the VAS and ODI scores significantly decreased,whereas the JOA score significantly increased in both groups(P<0.05).However,no statistical differences were found in aforesaid scores between the two groups at any corresponding time point(P>0.05).The excellent and good rate of clinical outcomes graded according to MacNabs criteria at the latest follow-up was of 89.66%in the VT group,whereas 86.21%in the conventional group,without a statistical significance(P>0.05).[Conclusion]In comparison with the conventional TESSYS technique,the visualized trephine with the advantages of simplifying surgical operation,reducing radiation exposure and improving the accuracy of foraminoplasty,is highly safe technique for percutaneous transforaminal endoscopy.

关 键 词：经皮脊柱内镜 腰椎间盘摘除 椎间孔成形 可视镜外环锯 

分 类 号：R681.53[医药卫生—骨科学]