可视化环锯在椎间孔镜侧路关节突成形的应用

Visual trephine for foraminoplasty in percutaneous endoscopic transforaminal discectomy

[目的]探讨可视化环锯关节突成形术在侧路椎间孔镜治疗腰椎间盘突出症的安全性和临床疗效。[方法]对2016年1月~2018年6月在徐州市中心医院脊柱外科确诊为单节段单侧LDH的61例患者的临床资料进行回顾性分析,其中可视化环锯关节突成形组(直视组) 31例,透视引导下逐级环锯关节突成形组(透视组) 30例。比较两组通道建立时间及透视次数,以及临床的影像评定结果。[结果]两组患者均顺利完成手术,除透视下引导环锯组有2例患者伤及行走神经根,致一过性感觉障碍外,两组患者均未发生严重并发症。直视组通道建立时间显著短于透视组[(34.13±5.32) min vs (44.43±6.14) min,P<0.05],直视组术中透视次数显著少于透视组[(3.23±0.81)次vs (9.80±1.19)次,P<0.05]。所有患者至少随访1年,均未发生椎间盘突出复发。两组患者VAS、ODI及JOA评分均随时间推移显著改善(P<0.05),但相应时间点两组间上述指标的差异均无统计学意义(P>0.05)。术后12个月直视组和透视组患者改良MacNab评价疗效优良率的差异无统计学意义(87.10%vs 86.67%,P>0.05)。影像测量方面,两组患者水平位移及角位移角较术前与术后不同时间点无显著变化(P>0.05),相同时间点比较,两组患者间差异均无统计学意义(P>0.05)。[结论]侧路椎间孔镜术治疗腰椎间盘突出症采用可视化环锯关节突成形可显著提升手术效率。

[Objective] To explore the effectiveness and the safety of visual trephine for foraminoplasty in percutaneous endoscopic transforaminal discectomy(PETD). [Methods] A retrospective study was conducted on 61 patients who underwent PETD for single segmental lumbar disc herniation(LDH) in our department from January 2016 to June 2018. Of them, 31 patients had foraminoplasty conducted by visual trephine(the visual group), while the remaining 30 patients received foraminoplasty with trephine under the guidance of the C-arm fluoroscopy(the fluoroscopy group). The perioperative data, including time for creating work channel and fluoroscopic frequency, clinical and radiographic consequences were compared between the two groups. [Results] The patients in both groups had operation conduced smoothly. Except temporary sensory disturbance happened in 2 patient of the fluoroscopy group due to outlet nerve injury, no serious complications occurred in anyone of both groups. The visual group consumed significantly shorter time to create the work channel [(34.13±5.32) min vs(44.43±6.14)min,P<0.05], associated with significantly less fluoroscopy frequency than the fluoroscopy group [(3.23±0.81) times vs(9.80±1.19) times, P<0.05]. The follow up period lasted for more than 1 year, and no reoccurrence of LDH happened in any patient of the both groups. The VAS, ODI and JOA scores significantly improved over time in both group(P<0.05), nevertheless no significant difference in any aforesaid parameter between the two group was proved at any matching time point(P>0.05). Based on the MacNab’s criteria, there was no significant difference in excellent and good rate of the clinical consequences between the two groups at 12 months postoperatively(87.10% vs86.67%, P>0.05). Regarding radiographic assessment, the horizontal displacement and angular displacement of involved segments remained unchanged after operation compared those before operation(P>0.05), and no a significant difference in these parameters was proved at any matching time point between the two groups(P>0.05). [Conclusion] The visual trephine used in foraminoplasty considerably enhance the efficiency of PETD for the treatment of single segmental LDH.