经椎间孔内镜技术穿刺路径辅助定位器的设计与临床应用

The design and clinical implication of trajectory-assisting puncture device in transforaminal percutaneous full-endoscopic lumbar discectomy

目的 ：阐述新型经椎间孔内镜技术穿刺路径辅助定位器（椎间孔镜定位器）的设计原理与使用方法 ,初步探索其对椎间孔镜手术穿刺的准确性、透视次数和手术时间的影响。方法：研制了新型椎间孔镜定位器,其设计原理主要是利用穿刺目标点始终落在直角圆弧圆心的特点实现导向穿刺。我们回顾性分析2015年5月1日~7月10日在我院接受椎间孔镜手术的患者,共纳入54例患者,男23例,女31例。使用椎间孔镜定位器进行穿刺的病例作为A组,使用传统穿刺方法的病例作为B组。记录并比较两组的穿刺次数、透视次数、手术时间和并发症等组间差异。结果：平均穿刺次数A组为1.22±0.57次,B组为5.89±1.91次,两组间具有显著性差异（P〈0.001）。平均透视次数A组为14.15±2.63次,B组为21.96±4.06次,两组间具有显著性差异（P〈0.001）。手术时间A组为81.37±10.62min,B组为90.41±14.37min,两组间有显著性差异（P=0.011）。两组之间均无重大并发症的发生,仅A组发现术后椎间盘残留1例,两组间并发症发生率无显著性差异（P=0.313）。结论：新型椎间孔镜定位器可以有效提高椎间孔镜穿刺的准确性,降低透视次数以及有效减少手术时间。

Objectives： To discuss the design principle and operation method of trajectory-assisting puncture device and its impact on puncture accuracy and fluoroscopic exposure as well as operation time of trans-foraminal percutaneous endoscopic lumbar discectomy（PELD）. Methods： The design principle of trajectory-assisting puncture device was to keep the target point always in the center of a guided arc. 54 patients under-going PELD were included in this retrospective study, 23 males and 31 females. Patients undergoing PELD were divided into two groups. Those receiving the self-made puncture-assisting puncture device were regarded as group A, and those undergoing conventional method was considered as group B. Puncture times, fluoro-scopic exposure and operation time were recorded and compared. Results： The average puncture times was1.22 ±0.57 in group A and 5.89 ±1.91 in group B（P 0.001）. The average fluoroscopic exposure time was14.15±2.63 in group A and 21.96±4.06 in group B（P〈0.001）. The average operation time was 81.37±10.62 min in group A and 90.41±14.37 min in group B（P=0.011）. There were no significant complications in group A and B, only 1 case with intervertebral disc residue postoperatively was found in group A. There was no sig-nificant difference in complication rate between the two groups（P=0.313）. Conclusions： Trajectory-assisting puncture device can significantly improve the puncture accuracy of PELD and reduce its fluoroscopy exposure as well as operation time, which indicates its great potential in the future clinical applications.