经椎间孔入路经皮内窥镜下椎间盘切除术联合三维导航技术治疗腰椎椎间盘突出症

Percutaneous endoscopic transforaminal discectomy combined with 3D navigation technology for treatment of lumbar disc herniation

目的探讨经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)联合三维导航技术治疗腰椎椎间盘突出症(LDH)的疗效及安全性。方法回顾性分析2015年1月-2016年6月接受PETD治疗的46例单节段LDH患者临床资料,其中22例采用三维打印模板导航技术穿刺(导航组),其余24例采用常规C形臂X线机透视引导穿刺(透视组)。比较2组手术时间、术中透视次数、穿刺时间及一次性穿刺成功率等指标,采用疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)评估疼痛缓解程度及腰椎功能改善情况,术后1年采用MacNab标准评价手术疗效。结果所有手术顺利完成。导航组手术时间、术中透视次数、穿刺时间显著低于透视组,一次性穿刺成功率显著高于透视组,差异均有统计学意义(P<0.05);2组术后1周、3个月、12个月VAS评分较术前显著降低,术后3、12个月ODI较术前显著降低,差异均有统计学意义(P<0.05)。术后12个月MacNab疗效评定,导航组优良率为95.45%(21/22),透视组优良率为91.67%(22/24),组间比较差异无统计学意义(P>0.05)。2组均无并发症发生。结论PETD联合三维导航技术治疗LDH手术和穿刺均用时减少,而且能减少透视次数、提高一次性穿刺成功率,值得临床推广。

Objective To investigate the efficacy and safety of percutaneous endoscopic transforaminal discectomy(PETD)combined with 3D navigation in the treatment of lumbar disc herniation(LDH).Methods Retrospective analysis was performed on the data of 46 patients with single-segment LDH who received PETD from January 2015 to June 2016.Among them,22 patients were treated with PETD combined with 3D navigation technique guided puncture(navigation group),and the remaining 24 patients with conventional C-arm X-ray fluoroscopy guided puncture(fluoroscopy group).The operation time,intraoperative fluoroscopy times,puncture time and single puncture success rate were compared.The visual analogue scale(VAS)score and Oswestry disability index(ODI)were used to evaluate the degree of pain relief and improvement of lumbar function.The modified MacNab criteria was used to evaluate clinical efficacy.Results All the operations were successfully completed.The operation time,intraoperative fluoroscopy times and puncture time of the navigation group were significantly lower than those of the fluoroscopy group,and single puncture success rate was significantly higher than that of the fluoroscopy group,all with a statistically significant difference(P<0.05).The VAS scores at postoperative 1 week,3 months and 12 months were significantly lower than those before surgery,and ODI at postoperative 3 and 12 months were significantly lower than those before surgery,both with a statistically significant difference(P<0.05).According to modified MacNab criteria,excellent and good outcome rate at postoperative 12 months was 95.45%(21/22)in the navigation group,and 91.67%(22/24)in the fluoroscopy group.There was no statistically significant difference between the 2 groups(P>0.05).No complications occurred in both groups.Conclusion PETD combined with 3D navigation technology in the treatment of LDH need less surgery and puncture time,can reduce the fluoroscopy times,and improve the single puncture success rate,thus being worthy of clinical promotion.