经皮椎间孔镜穿刺导向器的研制及其临床应用

Development and clinical application of the puncture guidance instrument for percutaneous transforaminal endoscopic discectomy

背景:经皮椎间孔镜手术是目前治疗腰椎间盘突出症最微创的术式,确保穿刺针能准确到达目标靶点是手术成功的关键。但经皮椎间孔镜技术有陡峭的学习曲线,初学者徒手穿刺容易导致穿刺不到位。目的:评价自行设计椎间孔镜穿刺导向器的穿刺导向准确性和安全性。方法:利用"直角三角形"原理设计出经皮椎间孔镜穿刺导向器。选择2014年1月至2016年7月在济宁医学院附属滕州市中心人民医院脊柱外科接受经皮椎间孔镜手术的单节段腰椎间盘突出症患者60例,随机分为2组,其中导向器组33例手术中辅助经皮椎间孔镜穿刺导向器完成手术,徒手组27例则采用徒手穿刺完成手术。比较2组患者穿刺次数、穿刺时间、透视次数及术后1年日本骨科协会评分、Oswestry功能障碍指数。结果与结论:(1)2组患者均顺利完成手术;(2)导向器组的穿刺次数、穿刺完成前透视次数、定位穿刺时间均小于徒手组,差异均有显著性意义(P<0.05);(3)2组患者术后1年随访,日本骨科协会评分及Oswestry功能障碍指数均较术前显著改善(P <0.05);2组之间日本骨科协会评分及Oswestry功能障碍指数相比,差异无显著性意义(P> 0.05);(4)提示根据"直角三角形"原理设计出的穿刺导向器可提高经皮椎间孔镜穿刺操作的准确性,尤其适用于初学者。

BACKGROUND:Percutaneous transforaminal endoscopic discectomy is currently the most minimally invasive treatment of lumbar disc herniation.It is essential to operation success that the puncture needle can accurately reach the target.But percutaneous transforaminal endoscopic discectomy has steep learning curve.Free hand can easily result in inadequate puncture.OBJECTIVE:To evaluate the puncture accuracy and safety of percutaneous puncture guidance instrument for percutaneous transforaminal endoscopic discectomy.METHODS:The design principle of puncture guidance instrument for percutaneous transforaminal endoscopic discectomy was right triangle.From January 2014 to July 2016,60 patients with lumber disc herniation were randomly divided into navigation group(n=33,percutaneous transforaminal endoscopic discectomy with a novel puncture guidance instrument)and free hand group(n=27,percutaneous transforaminal endoscopic discectomy with a free hand method).The times for puncture,puncture time,times for fluoroscopy,Japanese Orthopaedic Association score and Oswestry Disability Index at 1 year postoperatively were recorded and compared between two groups.RESULTS AND CONCLUSION:(1)All patients underwent the operation successfully.(2)The average puncture times,the average fluoroscopic exposure time and the preoperative location and puncture-channel time in the navigation group were significantly less than those in the free hand group(P<0.05).(3)Japanese Orthopaedic Association scores and Oswestry Disability Index at 1 year postoperatively in both groups were significantly improved compared with the baseline(P<0.05).The scores showed no significant differences between two groups(P>0.05).(4)Our results indicate that the puncture guidance instrument for percutaneous transforaminal endoscopic discectomy can improve the puncture accuracy,especially for a beginner.