混合现实技术导航联合椎间孔镜手术治疗腰椎间盘突出症应用研究

Applied research of mixed reality navigation combined with percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation

目的探讨混合现实(MR)技术导航联合经皮椎间孔镜腰椎间盘切除术(PTED)经椎间孔入路手术治疗腰椎间盘突出症(LDH)的可行性和临床疗效。方法回顾性将2018年3月至2020年6月福建医科大学附属第一医院收治的单间隙单侧突出LDH患者21例纳入本研究。体外研究:术前3D打印腰椎半透明模型,MR技术导航下经模型椎间孔穿刺并建立工作通道,直视下评价穿刺及通道放置效果。体内研究:21例患者均采用MR技术导航下经椎间孔入路PTED,分析患者围手术期资料,采用腰、腿痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)腰椎功能评分、改良Macnab标准和术后影像学检测结果评定手术疗效。结果MR技术导航下经模型椎间孔定位穿刺顺利,置入工作通道位置满意。体内研究手术操作顺利,随访时间平均(13.5±1.5)个月;术中穿刺次数平均(2.75±1.02)次,穿刺时间平均(9.33±0.82)min,透视次数平均(3.75±1.23)次,手术时间平均(95.70±18.55)min,术中出血量平均(7.23±1.30)mL,术后下地时间平均(8.53±0.92)h,术后住院治疗天数平均(1.73±0.23)d;术中透视通道位置满意,无中转开放手术,无神经根损伤、硬膜囊撕裂等并发症。术后1 d、3个月、12个月的腰、腿痛VAS评分、ODI、腰椎JOA评分均优于术前,差异均有统计学意义(P<0.05)。术后12个月采用改良Macnab标准评价手术效果:优16例,良3例,可2例,优良率90.48%。结论MR技术导航联合经椎间孔入路PTED治疗LDH可行、有效,穿刺时间短、辐射暴露少,具有较高的安全性、微创性及创新性。

Objective To investigate the feasibility and clinical efficacy of mixed reality technology navigation combined with percutaneous transforaminal endoscopic discectomy through transforaminal approach in the treatment of lumbar disc herniation.Methods A total of 21 patients with single level and unilateral symptoms LDH admitted to the First Affiliated Hospital of Fujian Medical University from March 2018 to June 2020 were retrospectively included in this study.In vitro study:3D translucent models of lumbar were printed.Guided by MR technology navigation,the models were punctured via intervertebral foramen and the working channels were established,and then,the positions were evaluated under direct vision.In vivo study:all patients were treated with PTED guided by MR technology navigation.The perioperative data were recorded,and clinical outcomes were evaluated by using visual analog scale(VAS)for low back pain and leg pain,oswestry disability index(ODI),Japanese Orthopaedic Association(JOA)lumbar function score,Macnab standard and postoperative imaging examination.Results Guided by MR technology navigation,the localization punctures via the model intervertebral foramen were smooth and the positions of working channels were satisfactory.All the operations were completed successfully.The average follow-up time was(13.5±1.5)months.The average number of intraoperative puncture was(2.75±1.02)times,the average puncture time was(9.33±0.82)minutes,the average number of fluoroscopy was(3.75±1.23)times,the average operation time was(95.70±18.55)minutes,the average amount of intraoperative bleeding was(7.23±1.30)mL,the average postoperative time out of bed was(8.53±0.92)hours,and the average number of postoperative hospital stay was(1.73±0.23)days.The positions of channels were satisfactory,and there were no complications such as open surgery conversion,nerve root injury and dural sac laceration All patients had superior waist and leg pain VAS scores,ODI,and JOA scores at 1day,3 months and 12 months after operation(P<0.05).According to the modified Macnab criteria,the results were excellent in 16 cases,good in 3 cases,and fair in 2 cases,the excellent and good rate was 90.48%.Conclusion Mixed reality navigation combined with the PTED through transforaminal approach does achieve safe and satisfactory clinical effect for LDH,and has advantages of short puncture time and less radiation exposure,with high safety,minimally invasive and innovation.