TESSYS技术治疗脱垂型腰椎间盘突出症穿刺头倾角的安全范围

Safety range of puncture cephalic tilt in transforaminal TESSYS technique for treatment of lumbar intervertebral disc prolapse

[目的]应用影像后处理软件(Vue PACS)行腰椎DR、CT、MRI测量经椎间孔入路TESSYS技术靶向治疗椎管内脱垂型腰椎间盘突出症的穿刺头倾角度安全范围,为TESSYS技术提供安全精确的参考数据;通过术前测定的穿刺头倾角安全范围在临床实践中验证TESSYS技术治疗椎管内脱垂型腰椎间盘突出症的安全性。[方法]选取2013年7月~2016年12月在本院接受经椎间孔入路的腰椎间盘髓核摘除手术治疗的椎管内脱垂型腰椎间盘突出症患者共59例。术前在本院Vue PACS上测量以下指标:髓核脱垂程度(MRI)、穿刺针进针深度及判断责任椎间孔是否狭窄(CT)、L_(3~4)、L_(4~5)、L_5~S_1椎间盘轻、重度脱垂的头倾角度安全范围(DR)。根据测量的头倾角范围判定是否能够达到预期穿刺目标以及手术有效率和安全性。[结果]按照术前测定的穿刺头倾角范围,所有患者穿刺均达到预定位置,手术有效率和安全性分别为90.6%、100%。L_(3~4)、L_(4~5)、L_5~S_1椎间隙头倾角安全范围中央型轻度脱垂为15°~30°,重度脱垂为40°~45°;非中央型轻度脱垂为35°~45°,重度脱垂为25°~30°。对于相同节段下不同脱垂程度及椎管内位置,其头倾角差异具有统计学意义(P<0.05)。[结论]术前可联合腰椎DR、CT、MRI初步测量并拟定穿刺进针的头倾角安全范围,即根据不同脱垂程度制定个性化手术入路,达到手术更加安全有效的目的。

[Objective] To investigate the safety range of puncture cephalic tilt in treatment of lumbar intervertebral disc prolapse by transforaminal approach using Thomas Hoogland endoscopy spine system （TESSYS） technique. [Methods] Fifty- nine patients with lumbar intervertebral disc prolapse underwent surgery to remove the prolapsed nucleus pulposus with transforaminal TESSYS from July 2013 to December 2016. Before operation, the extent of nucleus prolapse in the lumbar MRI, the depth of puncture needle and whether or not combined with stenosis of the involved intervertebral foramen in the lumbar CT were measured, additionally, safety ranges of cephalic tilt of puncture needle corresponding to the extent of nucleus prolapse at L3-4, L4-5and L5-S1 discs were mimicked in the lumbar digital radiographs with Vue PACS system. [Results] According to the safety ranges of cephalic tilt established before operation, the tip of TESSYS needle was accurately placed at the precalculated position in all patients, associated with surgical efficiency of 90.6% and safety of 100%. In central prolapse cases, the safety cephalic tilt angle ranged from 15° to 30° for the light prolapse, while from 40° to 45°for the severe prolapse. In non-central cases, the cephalic tilt angle was from 35° to 45° for the light prolapse, whereas from 25° to 30° for the severe prolapse. In the same segment, the ranges of cephalic tilt for different extents of disc prolapse proved statistically different （P〈0.05） . [ Conclusion] The safety range of cephalic tilt angle can be measured and determined preoperatively by lumbar DR, CT and MRI to develop personalized surgical approach. Therefore, more safe and effective surgical treatment can be achieved.