椎间孔镜手术中漂移法与骨钻椎间孔成形法放置工作套管的比较  

Comparison of working cannulas placement between drift method and bone drill arthroplasty in transforaminal endoscopic surgery

作　　者：张荣宜 朱本藩[1] 赵家贵[1] 赵龙[1] 王梓 王立奎[1] ZHANG Rongyi;ZHU Benfan;ZHAO Jiagui;ZHAO Long;WANG Zi;WANG Likui(Department of Pain Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院疼痛科,合肥230022

出　　处：《中国疼痛医学杂志》2022年第2期113-118,共6页Chinese Journal of Pain Medicine

基　　金：安徽省自然科学基金(1808085MH310);安徽医科大学第一附属医院博士科研基金(3101005001249)。

摘　　要：目的:探讨在经皮椎间孔镜腰椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)中采用漂移法放置工作套管的优势和价值。方法:回顾性分析2019年6月至2020年12月疼痛科收治的62例单节段腰椎间盘突出症病人行PTED手术的资料,其中32例采用骨钻椎间孔成形置管(A组),30例采用漂移法置管(B组)。比较两组术中透视次数及工作通道建立时间,采用视觉模拟评分法(visual analogue scale,VAS)评价工作通道建立过程中病人的疼痛情况。术后1月、3月和6月采用VAS评分及Oswestry功能障碍指数(Oswestry disability index,ODI)评估临床疗效,术后6月以改良Mac Nab标准评价手术优良率。结果:两组均顺利完成手术,无严重并发症发生。B组透视(14.3±5.1次),工作通道建立用时(22.2±5.7 min),较A组透视次数(25.9±7.8次)和工作通道建立用时(39.8±9.3 min)均显著减少(P<0.01)。B组放置工作通道过程中VAS评分显著低于A组,术后1月B组ODI评分较A组显著下降(P<0.01)。两组术后各时间点VAS评分和ODI评分较术前均显著下降(P<0.01),但两组之间术前、术后VAS评分及优良率比较均无统计学差异。结论:与骨钻椎间孔成形置管相比,漂移法置管同样可以满足手术要求,且显著缩短置管时间,降低辐射风险,减轻病人术中疼痛,值得在椎间孔镜手术中推广应用。Objective:To investigate the advantages and value of dilator drift cannula in percutaneous transforaminal endoscopic discectomy(PTED).Methods:A retrospective study was conducted on 62 patients with single segment lumber disc herniation who underwent PTED in our department from June 2019 to December 2020.Among them,32 cases were treated with bone drill for intervertebral foraminoplasty to place the working cannula(group A),while the remaining 30 cases were treated with the dilator drift method to place the working cannula(group B).The fluoroscopic exposure times and working cannula establishment time were compared between the two groups,and visual analogue scale(VAS)was used to evaluate the pain level of patients during the establishment of working cannulas.VAS score and Oswestry disability index(ODI)were used to assess clinical outcomes at 1 month,3 months and 6 months after operation,the excellent and good rates of the patients were evaluated by the modified MacNab criteria at 6 months after operation.Results:The operations of the two groups were successfully completed without serious complications.Compared with the group A(25.9±7.8)the fluoroscopic exposure times of group B(14.3±5.1)was significant decreased(P<0.01),Compared the working cannula establishment time of group A(39.8±9.3 min),group B(22.2±5.7 min)was significant decreased(P<0.01).In addition,the VAS score during the establishment of working cannulas in group B was significantly lower than that in group A(P<0.01),the ODI in group B was significantly lower than that in group A one month after the operation(P<0.01).The VAS score and ODI of the two groups were significantly lower than those before operation(P<0.01),but there was no significant difference in VAS scoreand excellent and good rates between the two groups before and after operation.Conclusion:Compared with the bone drilling intervertebral foraminoplasty cannula,the dilator drifting cannula can also meet the operation requirements,and significantly shorten the establishment time of workin

关 键 词：漂移法置管 经皮椎间孔镜腰椎间盘切除术 腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]