Mimics虚拟手术规划在经椎间孔入路经皮内窥镜下椎间盘切除术治疗L_5/S_1椎间盘突出症中的应用

Application of Mimics virtual surgery design in percutaneous endoscopic transforaminal discectomy for L_5/ S_1 disc herniation

目的评价Mimics虚拟手术规划在经椎间孔入路经皮内窥镜下椎间盘切除术（percutaneous endoscopic transforaminal discectomy,PETD）治疗L5/S1椎间盘突出症中的应用价值。方法 2013年8月-2015年4月,根据纳入与排除标准将符合研究条件的72例病例纳入研究,随机分为试验组和对照组,每组36例。试验组采用Mimics软件重建腰椎三维模型,术前在计算机上模拟L5/S1PETD穿刺置管,寻找最佳穿刺路径;对照组采用经验式穿刺方法。比较2组术中通道建立时间、镜下操作时间、X线透视次数。采用日本骨科学会（Japanese Orthopaedic Association,JOA）评分、疼痛视觉模拟量表（visual analogue scale,VAS）评分评价临床疗效,观察手术并发症。结果试验组的通道建立时间、镜下操作时间和术中X线透视次数均较对照组明显减少,差异有统计学意义（P〈0.01）。2组术后1 d和术后6个月的VAS和JOA评分均较术前明显改善,差异有统计学意义（P〈0.01）。2组之间手术前后各时间点VAS和JOA评分比较,差异均无统计学意义（P〉0.05）。2组患者均未发生神经损伤、硬膜囊撕裂、血肿及椎间隙感染等并发症。结论 Mimics虚拟手术规划有助于提高PETD的穿刺置管成功率,有效缩短穿刺置管时间及镜下操作时间,减少术中透视次数。

Objective To evaluate the value of Mimics virtual surgery design in percutaneous endoscopic transforaminal discectomy（ PETD） for L5/ S1 disc herniation. Methods From August 2010 to April 2015,72 cases were chosen in the study according to inclusion and exclusion criteria,and they were randomly divided into experimental and control groups. There were36 cases in the experimental group and 36 cases in the control group. The experimental group adopted Mimics software to rebuild 3D lumbar spinal model. Transforaminal puncture was simulated by the computer to find the optimal direction,and then the cases underwent PETD. The control group adopted a conventional puncture method. The clinical data（ approach establishment time,endoscopic operation time,X-ray perspective times,clinical effect and surgical complications） of the 2groups were observed. The visual analogue scale（ VAS） scores and the Japanese Orthopaedic Association（ JOA） scores were used to evaluate the effect. Results Approach establishment time was（ 29. 47 ± 4. 21） min in experimental group and（ 35. 09 ± 4. 35） min in control group; the difference between 2 groups was statistically significant（ P〈0. 01）. Endoscopic operation time was（ 47. 67 ± 6. 98） min in experimental group and（ 53. 83 ± 6. 23） min in control group; the difference between 2 groups was statistically significant（ P〈0. 01）. X-ray perspective times was 23. 69 ± 4. 82 in experimental group and 32. 89 ± 5. 09 in control group; the difference between 2 groups was statistically significant（ P〈0. 05）. The VAS scores were 6. 64 ± 0. 89 at pre-operation,1. 72 ± 0. 61 at postoperative 1 d and 0. 75 ± 0. 55 at postoperative 6 months in experimental group. The VAS scores were 6. 34 ± 0. 84 at pre-operation,1. 60 ± 0. 61 at postoperative 1 d and 0. 80 ± 0. 68 at postoperative 6 months in control group. Compared with the pre-operation,the difference was statistically significant in both groups（ P〈0. 05）. The JOA scores were 16. 31 ± 2. 56 at pre-operation,20. 71 ± 2. 50 at postoperative 1 d and 25. 86 ±2. 11 at postoperative 6 months in experimental group. The JOA scores were 15. 83 ± 2. 75 at pre-operation,19. 97 ± 2. 27 at postoperative 1 d and 25. 46 ± 2. 19 at postoperative 6 months in control group. Compared with the pre-operation,the difference was statistically significant in both groups（ P〈0. 05）. There was no significant difference in VAS and JOA scores between the 2 groups at each time point（ P〈0. 05）. No complications such as neurological damage,hematoma and infection occurred in the 2 groups. Conclusion Mimics virtual surgery design can improve the successful rate of puncture,and also can reduce the endoscopic operation time and the X-ray perspective times.