2种不同经皮穿刺置钉法在腰椎间盘突出症手术中的疗效对比

Comparison of two kinds of percutaneous nail insertion in lumbar disc herniation surgery

目的比较导航引导下经皮穿刺普通螺钉植入术与常规经皮穿刺空心螺钉植入术治疗腰椎间盘突出症的临床疗效。方法收集自2012年1月-2016年12月间本医疗组收治并且手术方案采用经皮穿刺治疗的腰椎间盘突出的患者60例,分为导航下经皮穿刺普通螺钉植入术组(导航组)37例和常规经皮穿刺空心螺钉植入术组(常规组)23例。比较2组VAS评分、JOA评分、功能残障指数评分(ODI)、术中术者辐射暴露量、置钉准确率、住院天数、医疗花费等指标。结果导航组的术中手术时间、术中出血量、辐射暴露量、穿刺次数、住院天数、医疗花费以及置钉情况均优于常规组(P<0.05)。结论导航引导下经皮穿刺技术和常规C臂引导下经皮穿刺技术在治疗腰椎间盘突出方面都能取得相当的短期临床疗效,并且三维导航引导下经皮穿刺技术具有精准、安全、加速术后康复、降低医疗花费等优点,该技术将可能成为微创置钉的首选方案之一。

Objective To compare the clinical effect of guided percutaneous screw implantation and conventional percutaneous hollow screw implantation in the treatment of lumbar intervertebral disc. Methods The clinical data of patients with lumbar disc herniation treated with percutaneous puncture from January 2012 to December 2016 was collected. They were divided into navigational percutaneous common screw implantation group（navigation group） and conventional percutaneous hollow screw implantation group（conventional group）. There were 37 cases in the navigation group and 23 cases in the conventional group. The clinical indexes included VAS, JOA score, functional disability index score, operation time, intraoperative radiation exposure of the surgeon, nailing accuracy, hospitalization days, and medical expenses. Results The operation time, intraoperative bleeding volume, the amount of moderate radiation storm, number of punctures, the days of hospitalization, the cost of medical treatment and nailing condition in the navigation group were better than those in the routine group（P〈0.05）. Conclusion The navigation-guided percutaneous puncture technique and conventional C-arm guided percutaneous puncture technique can both produce considerable short-term clinical efficacy in the treatment of lumbar intervertebral disc herniation in young and middle-aged patients. Percutaneous puncture technology guided by three-dimensional navigation has the advantages of accuracy, safety, accelerated postoperative rehabilitation, and reduced medical costs, which may become one of the first choices for minimally invasive placement.