3D打印技术辅助全脊柱内镜精准开窗髓核摘除术治疗高度游离型腰椎间盘突出症的疗效观察  

Clinical efficacy of 3D printing technology-assisted precise fenestration nucleus pulposus removal in treatment of highly free lumbar disc herniation

作　　者：李鹏[1] 李想[1] 马琳[1] 赵静 郭强[1] 张鹏飞[1] 聂富祥[1] 贺海怿 LI Peng;LI Xiang;MA Lin;ZHAO Jing;GUO Qiang;ZHANG Peng-fei;NIE Fu-xiang;HE Hai-yi(Department of Spine,Sanmenxia Central Hospital,Sanmenxia,Henan 472000,China)

机构地区：[1]三门峡市中心医院脊柱外科,河南472000

出　　处：《中国骨与关节损伤杂志》2023年第1期25-29,共5页Chinese Journal of Bone and Joint Injury

基　　金：三门峡市科技发展项目(2021004035)。

摘　　要：目的分析3D打印技术辅助全脊柱内镜精准开窗髓核摘除术治疗高度游离型腰椎间盘突出症的临床疗效。方法纳入自2017-01—2021-02手术治疗的72例高度游离型椎间盘突出症,随机分为观察组与对照组,观察组34例采用3D打印技术辅助内镜精准开窗,对照组38例采用传统内镜开窗。比较两组手术时间、穿刺次数、X线透视次数,以及术后1周、3个月、1年的疼痛VAS评分、JOA评分、ODI指数。结果72例均获得随访,随访时间12~18个月,平均14.5个月。观察组手术时间较对照组短,穿刺次数、X线透视次数少于对照组,差异有统计学意义(P<0.05)。观察组术后1周、3个月、1年的疼痛VAS评分、JOA评分、ODI指数较术前明显改善,差异有统计学意义(P<0.05);对照组术后1周、3个月、1年的疼痛VAS评分、JOA评分、ODI指数较术前明显改善,差异有统计学意义(P<0.05)。两组术后1周、3个月、1年的疼痛VAS评分、JOA评分、ODI指数差异无统计学意义(P>0.05)。结论通过3D打印模型可更为直观地观察高度游离型腰椎间盘突出症患者的突出物与骨性结构的关系,在一定程度上克服了解剖结构特殊的不利影响因素,在术前规划穿刺路径、骨性结构切除范围方面具有良好的辅助作用,可以有效减少手术时间、术中穿刺次数、X线透视次数,降低神经根及硬膜囊损伤发生率。Objective To analyze the clinical efficacy of 3D printing technology assisted total spinal endoscopic precise fenestration nucleus pulposus removal in the treatment of highly free lumbar disc herniation.Methods Seventy-two cases of highly free lumbar disc herniation treated from January 2017 to February 2021 were randomly divided into observation group and control group.3D printing assisted endoscopic precise fenestration was used in 34 cases of observation group while the traditional endoscopic fenestration was employed in 38 cases of the control group.The operation time,number of punctures,number of Xrays as well as pain VAS score,JOA score and ODI index were compared between the two groups,1 week,3 months and 1 year after surgery.Results All 72 cases were followed up for 12~18 months,with an average of 14.5 months.The operation time of the observation group was shorter than that of the control group,and the number of punctures and X-ray fluoroscopy were lower than those of the control group,and the difference was statistically significant(P<0.05).The pain VAS score,JOA score and ODI index of 1 week,3 months and 1 year after surgery in the observation group were significantly improved compared with those before surgery(P<0.05).The pain VAS score,JOA score and ODI index of 1 week,3 months and 1 year after surgery in the control group were significantly improved compared with those before surgery(P<0.05).There was no significant difference in pain VAS score,JOA score and ODI index at 1 week,3 months and 1 year after surgery between the two groups(P>0.05).Conclusion The 3D printed model can facilitate more intuitive observation of the relationship between the protrusion of highly free lumbar disc herniation and the nerve root and bony structure.It can overcome the special influencing factors of anatomical structure to a certain extent with a good auxiliary role in planning the puncture route and the scope of bone structure resection before surgery to effectively reduce the operation time,the number of intraoperati

关 键 词：高度游离型腰椎间盘突出症 椎板间入路 脊柱内镜 3D打印技术 

分 类 号：R681.5[医药卫生—骨科学]