三维椎间孔导向器的设计及其在经皮椎间孔镜下腰椎间盘切除术中的应用

Design of three-dimensional foraminal guide device and application in percutaneous endoscopic lumbar discectomy

目的:探讨三维椎间孔导向器在经皮椎间孔镜下腰椎间盘切除术的应用效果。方法:利用逆向定位原理,设计出三维椎间孔导向器。自2016年5月至2018年5月,将三维椎间孔导向器应用于临床,共40例单节段腰椎间盘突出症患者接受了经椎间孔入路腰椎间盘切除术,根据是否应用三维椎间孔导向器,分为导向器组和对照组,每组20例。导向器组男9例,女11例;年龄(46.0±11.0)岁;L3,45例,L4,515例;BMI(25.4±3.2)kg/m2;使用三维导向器进行穿刺置管。对照组男10例,女10例;年龄(51.8±9.8)岁;L3,44例,L4,516例;BMI(24.8±3.5)kg/m2;以术中经验进行常规穿刺置管。比较两组患者穿刺时间、透视次数和穿刺次数,以及手术前后下肢视觉模拟疼痛评分(visual analogue scale,VAS)及腰椎日本骨科协会评分(Japanese Orthopaedic Association,JOA)。结果:所有患者无严重手术并发症发生,并顺利完成手术。导向器组手术时间、透视次数和穿刺次数均小于对照组(P<0.05)。两组患者术后3个月下肢VAS评分和腰椎JOA评分较术前均明显缓解(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论:三维椎间孔导向器结构紧凑,操作简单,可以减少穿刺次数与辐射损伤,并能缩短初学者穿刺学习曲线,具有一定的临床可行性。

Objective:To explore clinical application of the new three-dimensional foramen guide in percutaneous endoscopic lumbar discectomy.Methods:Based on the principle of reverse positioning,a new three-dimensional foramen guide was designed.From May 2016 to May 2018,totally 40 patients with segmental lumbar disc herniation were underwent percutaneous endoscopic lumbar discectomy.The patients were divided into guide and control group,and 20 patients in each group.In guide group,there were 9 males and 11 females with an average age of(46.0±11.0)years old;5 patients on L3,4,15 patients on L4,5;BMI was(25.4±3.2)kg/m2;three dimensional foramen guide was used to assist the operation.While in control group,there were 10 males and 10 females with an average age of(51.8±9.8)years old;4 patients on L3,4,16 patients on L4,5;BMI was(24.8±3.5)kg/m2;the operation was completed with bare hands according to the experience.The puncture time,times of fluoroscopy and puncture between two groups were compared,as well as the preoperative and postoperative visual analogue scale(VAS)score and Japanese Orthopaedic Association(JOA)were compared.Results:All patients had no serious complications,and successfully completed operation.Operation time,the times of fluoroscopy and puncture in guide group were better than those of control group(P<0.05).VAS score and JOA score between two groups were significantly relieved after operation(P<0.05),but there was no significant difference between two groups(P>0.05).Conclusion:The three-dimensional foramen guide is compact in structure,simple in operation,which could reduce the time of puncture and damage of radiation,shorten the learning curve of puncture for beginners,and has certain clinical feasibility.