MED术前模拟手术体位下摄X线片定位的方法及临床意义

Study on Preoperative Localization Methods of Micro-endoscopic Disectomy by Taking Radiography in Operation Position and Its Clinical Value

【目的】探讨显微内窥镜下腰椎间盘摘除术(MED)术前模拟手术体位下摄X线片定位的方法及其临床意义。【方法】根据手术时体位,设计一模拟手术体位台架。选取本院于2006年8月至2007年2月的83例腰椎间盘突出症(LIDH)患者行MED治疗的病例,术前均摄普通体位下的腰椎正侧位X线片及模拟手术体位下的腰椎正侧位X线片。在患者俯卧于模拟手术体位台架上摄片前,在相应椎间隙的上位棘突旁皮肤上置一金属标记物。术中根据定位片上椎间隙及棘突的对应关系指导导针穿刺定位,穿刺后"C"臂X线机确认。【结果】83例患者,共施术93节椎间隙,1次穿刺准确率为100%。【结论】术前模拟手术体位下摄X线片定位方法,准确率高,能缩短手术中的定位时间和减少射线量,是临床上施行MED术的一种实用、可靠的术前定位方法。

[Objective]To investigate the localization methods by taking radiography in operation position before micro-endoscopic disectomy （MED） and its clinical value, [Methods] Eighty three cases of lumbar intervertebral disc herniation treated by MED were selected, All patients have taken both AP and lateral radiography respectively in common posture and in operation position. A metal marker on the side of upper processus spinosus of corresponding intervertebral space was put before taking radiography in sham operative posture, Then the needle guided by x ray pictures was used to puncture target intervertebral space and the position was confirmed with C-arm. [Results] Eighty three cases （93 interspinal spaces） underwent this kind of surgery and the puncture accuracy was 100%. [Conclusion]Location by taking photographs in sham operative posture before MED is a practical and reliable method and has advantages of high accuracy, short location time and few radiation dosage.