三维可视化虚拟手术系统在经皮内镜下经椎间孔椎间盘切除术中的应用研究  

Application of Three-dimensional Visualization Virtual Surgery System in Percutaneous Transforaminal Endoscopic Discectomy

作　　者：巩陈 吴建明 张文志 刘向阳 石志伟 段端强 Gong Chen;Wu Jianming;Zhang Wenzhi(Department of Spine Surgery,Bozhou Hospital Affiliated to Anhui Medical University,Bozhou 236800,China;不详)

机构地区：[1]安徽医科大学附属亳州医院脊柱外科,亳州236800 [2]中国科学技术大学附属第一医院脊柱外科,合肥230036

出　　处：《中国微创外科杂志》2023年第9期668-675,共8页Chinese Journal of Minimally Invasive Surgery

基　　金：安徽省重点研究与开发计划项目(202104j07020053);安徽医科大学附属亳州医院三新项目(2021ZDA-01)。

摘　　要：目的探讨采用三维可视化虚拟手术系统(three-dimensional visualization virtual surgery system,3DVVSS)联合自制椎间孔定位穿刺器(intervertebral foramen positioning puncture device,IFPPD)在经皮内镜下经椎间孔椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症(lumbar disc herniation,LDH)中的应用效果。方法2021年1月~2022年2月我科70例LDH接受PETD,采用随机数字表法选择通道建立方法,35例采用3DVVSS联合IFPPD建立通道(可视化组),35例采用传统徒手方法建立通道(传统组),通道建立后采用经椎间孔内镜脊柱系统(transforaminal endoscopic spine system,TESSYS)完成椎间盘切除和神经根减压。比较2组穿刺次数、穿刺时间、透视次数、手术时间、住院时间、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)和并发症发生情况。结果70例顺利完成手术,无并发症发生。可视化组穿刺时间明显短于传统组[(14.7±4.0)min vs.(19.1±3.7)min,t=-4.765,P=0.000],穿刺次数明显少于传统组[(3.8±1.9)次vs.(7.3±2.4)次,t=-6.898,P=0.000],透视次数明显少于传统组[(8.3±3.1)次vs.(14.5±4.0)次,t=-7.370,P=0.000],手术时间明显短于传统组[(78.3±9.2)min vs.(88.4±14.3)min,t=-3.528,P=0.001]。2组术后VAS评分和ODI均优于术前,差异有统计学意义(均P=0.000)。结论PTED治疗LDH采用3DVVSS联合IFPPD可以明显减少穿刺次数、透视次数,缩短穿刺时间和手术时间,穿刺准确性高,手术效果满意,方法可行。Objective To investigate the application effect of the three-dimensional visualization virtual surgery system(3DVVSS)combined with the self-made intervertebral foramen positioning puncture device(IFPPD)for percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation(LDH).Methods From January 2021 to February 2022,70 patients with LDH in our department underwent PTED.The random number table method was used to select the channel establishment method.A total of 35 cases were treated with 3DVVSS combined with the self-made IFPPD to establish channel(visualization group),and another 35 cases were treated with traditional manual method(traditional group).After the channels were established,the TESSYS technology was used to complete the discectomy and nerve root decompression.The puncture times,puncture time,fluoroscopy times,operation time,hospitalization time,visual analogue scale(VAS),Oswestry disability index(ODI),and complications were compared between the two groups.Results The operations were successfully completed in all the 70 patients,without serious complications.The visualization group was significantly shorter than the traditional group in terms of puncture time[(14.7±4.0)min vs.(19.1±3.7)min,t=-4.765,P=0.000].The number of punctures in the visualization group was significantly lower than that in the traditional group[(3.8±1.9)times vs.(7.3±2.4)times,t=-6.898,P=0.000].The fluoroscopy times in the visualization group was significantly lower than that in the traditional group[(8.3±3.1)times vs.(14.5±4.0)times,t=-7.370,P=0.000].The surgical time in the visualization group was significantly shorter than that in the traditional group[(78.3±9.2)min vs.(88.4±14.3)min,t=-3.528,P=0.001].The VAS and ODI in each group were better than preoperation,with differences statistically significant(all P=0.000).Conclusions The application of 3DVVSS combined with the self-made IFPPD in PETD can significantly reduce the puncture times,fluoroscopy times,puncture time,and operation time

关 键 词：经皮内镜手术 椎间孔成形 经椎间孔减压 腰椎间盘突出症 透视 

分 类 号：R687.3[医药卫生—骨科学]