基于术中C臂X光图像骨性标识的椎间孔镜手术路径构建  

Construction of a transforaminal endoscopic surgical path based on bone landmarks in intraoperative C-arm X-ray radiographs

作　　者：张翼翔 梁原浩 杨文龙 李国强 吴文庆 刘垒 ZHANG Yixiang;LIANG Yuanhao;YANG Wenlong;LI Guoqiang;WU Wenqing;LIU Lei(College of Traditional Chinese Medicine,Shandong Second Medical University,Weifang 261053,Shandong,China;Department of Public Service,Yantai Preschool Teachers College,Yantai 265600,Shandong,China;Department of Pain Medicine,The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,Shandong,China)

机构地区：[1]山东第二医科大学中医学院,山东潍坊261053 [2]烟台幼儿师范高等专科学校公共服务系,山东烟台265600 [3]山东第一医科大学第一附属医院疼痛科,山东济南250014

出　　处：《山东大学学报(医学版)》2025年第3期14-21,共8页Journal of Shandong University:Health Sciences

基　　金：山东省重点研发计划(2022CXGX020510);齐鲁医派中医学术流派传承项目(鲁卫函[2022]93号);2020年度齐鲁卫生与健康领军人才培育工程项目(鲁卫人才字[2020]3号);2024第一批山东省体卫融合示范项目(鲁体办字[2023]28号)。

摘　　要：目的通过分析腰椎薄层CT图像,归纳椎间孔镜侧路穿刺定位的规律;依据术中C臂X光骨性标识构建椎间孔镜手术路径,应用于临床验证其安全性及有效性。方法①选取山东第一医科大学第一附属医院2022年1月至2024年5月收治的30例腰椎间盘突出症(lumbar disc herniation,LDH)患者腰椎薄层CT图像,通过影像解剖研究,探究椎间孔镜侧路穿刺规律,确立术中C臂X光图像上骨性标记交叉线定点穿刺方法,构建安全有效的椎间孔镜穿刺路径。②选取2023年5月至2024年5月我院收治的行孔镜手术LDH患者80例,按随机数字表法分为交叉点定位法组(n=40)和体表定位法组(n=40)。所有患者均行侧路椎间孔镜手术治疗,手术均由具备熟练操作脊柱内镜手术的高年资医师按照随机分配原则进行。分析两组临床疗效、术中各指标及术后并发症等。结果交叉点定位法组总有效率高于体表定位法组,两组差异有统计学意义(P<0.05);一次穿刺成功率交叉点定位法组97.5%,体表定位法组80%,两组差异有统计学意义(P<0.05);建立工作通道时间交叉点定位法组(16.32±3.97)min,体表定位法组(26.32±5.93)min,两组差异有统计学意义(P<0.05);平均透视次数交叉点定位法组(8.93±2.12)次,体表定位法组(17.53±2.73)次,两组差异有统计学意义(P<0.001);术中透视辐射剂量交叉点定位法组为(10.27±5.72)mGy,体表定位法组为(17.16±4.27)mGy,两组差异有统计学意义(P<0.01);交叉点定位法组术后疼痛视觉模拟评分、Oswestry功能障碍指数较体表定位法组下降明显(P<0.05);两组均未发生严重并发症。结论交叉点定位法相比既往穿刺定位方法优势显著,为椎间孔镜手术提供一种安全且有效、精准易标识、简便易掌握的穿刺定位方法。Objective To summarise the rules of lateral puncture positioning for the intervertebral foramen endoscopy by analyzing thin-slice CT images of the lumbar spine and to construct a surgical path for intervertebral foramen endoscopy based on the intraoperative C-arm X-ray bone landmarks,so as to apply it to clinical verification of its safety and effcacy.Methods①Thirty patients with lumbar disc herniation(LDH)admitted to The First Affiliated Hospital of Shandong First Medical University from January 2022 to May 2024 were selected for lumbar thin-layer CT imageing.The rules of lateral puncture of intervertebral foramen endoscopy were explored through imaging anatomy research,and the method of fixed-point puncture of the cross line of bone landmarks on intraoperative C-arm X-ray imageing was established to construct a safe and effective puncture path of intervertebral foramen endoscopy.②Eighty patients with LDH who underwent intervertebral foramen endoscopy surgery in our hospital from May 2023 to May 2024 were selected and divided into the cross-point positioning method group(n=40)and the surface positioning method group(n=40)according to the random number table method.All patients underwent lateral foraminal endoscopic surgery,and the surgery was performed by senior physicians experienced in spinal endoscopic surgery according to the principle of random allocation.The clinical efficacy,intraoperative parameters and postoperative complications of the two groups were observed and analysed.Results The overall efficacy rate of the observation group was higher than that of the control group,and the difference between the two groups was statistically significant(P<0.05).The single puncture success rate was 97.5%in the cross-point positioning method group and 80%in the surface positioning method group,and the difference between the two groups was statistically significant(P<0.05).The time to establish the working channel was(16.32±3.97)min in the cross-point positioning method group and(26.32±5.93)min in the surface

关 键 词：手术路径构建 椎间孔镜手术 影像解剖 骨性标识 C臂X光 

分 类 号：R615[医药卫生—外科学]