C形臂引导下椎间孔镜穿刺体表定位技术的教学体会  

Teaching experience of surface positioning technology for transforaminalendoscopic puncture guided by C-arm

作　　者：赵家贵[1] 张荣宜 胡军 陆姚[2] ZHAO Jiagui;ZHANG Rongyi;HU Jun;LU Yao(Department of Pain Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China;不详)

机构地区：[1]安徽医科大学第一附属医院疼痛科,安徽合肥230022 [2]安徽医科大学第一附属医院日间手术中心

出　　处：《中华全科医学》2025年第5期862-866,共5页Chinese Journal of General Practice

基　　金：安徽省转化医学研究院科研基金项目(2023zhyx-C45)。

摘　　要：目的本文旨在探讨教学中应用C形臂X线透视下的经皮椎间孔镜的体表定位技术,评估该技术在脊柱外科及疼痛科椎间孔镜手术教学中的效果,尤其是针对初学者如何快速掌握定位穿刺技巧的实践经验。方法选择2024年11—12月于安徽医科大学第一附属医院疼痛科接受经皮椎间孔镜治疗的36例腰椎间盘突出症患者,根据所用技术不同分为YESS技术组、THESS技术组和可视化椎间孔成形术组,每组12例。通过C形臂X线透视对穿刺点进行定位,采用不同技术进行体表定位与穿刺,并评估每组的透视次数、穿刺时间及学员的教学满意度。结果使用可视化椎间孔成形术组的穿刺时间[(8.6±2.0)min]和透视次数[(6.0±1.9)次]均明显低于YESS技术组[(12.6±2.6)min和(9.6±2.1)次]和THESS技术组[(13.1±5.1)min和(10.7±2.6)次,P<0.05]。此外,学员对可视化椎间孔成形术的教学满意度评分[(93.8±4.3)分]显著高于YESS技术组[(71.1±11.0)分]和THESS技术组[(63.3±7.1)分,F=47.590,P<0.001]。结论C形臂X线透视引导下的经皮椎间孔镜定位穿刺技术,在腰椎间盘突出症的治疗中具有重要的临床价值,明显减少穿刺时间。通过简化的穿刺定位方法,初学者能够在较短时间内熟练掌握技术,显著减少了透视次数和手术时间,同时提升了学员的学习满意度。因此,该方法具有较高的推广价值,有助于减少患者的辐射暴露,并促进该技术在脊柱外科及疼痛科临床实践中的应用。Objective This study aims to explore the surface positioning technology of percutaneous transforaminal endoscopic lumbar discectomy under C-arm X-ray fluoroscopy in teaching,and to evaluate the effect of this technology in the teaching of transforaminal endoscopic lumbar discectomy in spinal surgery and pain department,especially the practical experience of how beginners can quickly master the positioning puncture skills.Methods Thirty-six patients with lumbar disc herniation who received percutaneous transforaminal endoscopic lumbar discectomy in the Department of Pain,the First Affiliated Hospital of Anhui Medical University from November to December 2024 were selected and divided into YESS technology group,THESS technology group and visualized foraminoplasty group according to the different technologies used,with 12 cases in each group.The puncture point was located by C-arm X-ray fluoroscopy,and different technologies were used for surface positioning and puncture.The number of fluoroscopy,puncture time,and teaching satisfaction of the trainees in each group were evaluated.Results The puncture time[(8.6±2.0)min]and the number of fluoroscopy[(6.0±1.9)times]of the group using visual foraminoplasty were significantly lower than those of the YESS group[(12.6±2.6)min and(9.6±2.1)times]and the THESS group[(13.1±5.1)min and(10.7±2.6)times,P<0.05].In addition,the trainees'teaching satisfaction score for visual foraminoplasty(93.8±4.3)was significantly higher than that of the YESS group(71.1±11.0)and the THESS group(63.3±7.1,F=47.590,P<0.001).Conclusion The percutaneous foraminoscopic puncture technique under the guidance of C-arm X-ray fluoroscopy has important clinical value in the treatment of lumbar disc herniation and significantly reduces the puncture time.Through the simplified puncture positioning method,beginners can master the technique in a short time,significantly reducing the number of fluoroscopy and operation time,while improving the learning satisfaction of trainees.Therefore,this method has a

关 键 词：腰椎间盘突出症 椎间孔镜 定位 穿刺 C形臂 侧路椎间孔镜技术 

分 类 号：R192[医药卫生—卫生事业管理] R681.53[医药卫生—公共卫生与预防医学]