混合现实技术与X射线透视引导椎间孔镜治疗腰椎间盘突出症的比较研究

Comparative study on mixed reality navigation and fluroscopic guidance combined with percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation

目的比较混合现实(MR)技术导航与传统X射线透视引导经皮椎间孔镜腰椎间盘切除术(PTED)治疗腰椎间盘突出症(LDH)的临床疗效。方法选择2018年6月至2020年9月福建医科大学附属第一医院收治的单节段LDH患者39例,根据手术辅助设备不同分为两组:MR技术导航PTED组(导航组)18例,X射线透视引导PTED组(透视组)21例。记录两组患者围手术期相关资料。采用腰、腿痛视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)和日本骨科协会(JOA)腰椎功能评分评估手术疗效。结果随访12~18个月,平均(14.5±1.2)个月。所有患者均无中转开放手术,无大出血、神经根损伤、椎间隙感染和硬脊膜撕裂等严重并发症发生。穿刺满意度:导航组优15例,良2例,可1例,优良率94.44%,透视组优良率90.48%。与透视组比较,导航组穿刺及透视次数减少,穿刺及手术时间缩短,患者术中穿刺疼痛VAS评分更低(P<0.05);两组手术切口长度、术中出血量、术后下地及术后住院时间无明显差异(P>0.05)。两组患者术后1 d、术后3、12个月的腰、腿痛VAS评分、ODI均较术前明显降低,腰椎JOA评分均较术前明显升高(P<0.05),两组间术后各时间点上述指标无明显差异(P>0.05)。结论MR技术导航下经椎间孔定位穿刺准确、有效,MR技术导航与X射线透视引导经椎间孔入路PTED治疗LDH均可取得满意的结果,导航手术具有更高的安全性和微创性。

Objective To compare the clinical efficacy of mixed reality(MR)navigation and traditional fluroscopic guidance combined with percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation(LDH).Methods From June 2018 to September 2020,a total of 39 patients with single-level LDH admitted to the First Affiliated Hospital of Fujian Medical University were selected and divided into two groups according to different surgical auxiliary equipment.Among them,18 patients were treated with PTED guided by MR navigation(the navigation group),and 21 patients were treated with PTED guided by X-ray fluoroscopy(the fluoroscopy group).The perioperative data of the two groups were recorded.The surgical efficacy were evaluated by using visual analogue scale(VAS)for low back pain and leg pain,Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)lumbar function score.Results The patients were followed up for 12-18 months,with an average of(14.5±1.2)months.There were no serious complications,such as hematorrhea,nerve root injuries,intervertebral disc space infection and dural tear in both groups.The puncture satisfaction was graded as excellent in 15 cases,good in two cases,and fair in one case,with an excellent and good rate of 94.44%in the navigation group.And the excellent and good rate was 90.48%in the fluoroscopy group.Compared with the fluoroscopy group,the navigation group consumed significantly shorter operation and puncture time,associated with lower VAS score of intraoperative pain,less frequent intraoperative puncture(P<0.05).Between the two groups,there were no significant differences in the incision length,intraoperative blood loss,postoperative landing time,and hospitalization time(P>0.05).The VAS scores and ODI of lumbar and leg pain at postoperative one day,three months and 12 months were significantly lower than those before surgery,and the JOA scores of lumbar spine were significantly higher than those before surgery(P<0.05).There was no significant difference in the above indicators at each time point after operation between the two groups(P<0.05).Conclusion The transforaminal positioning and puncture guided by MR navigation is accurate and effective.The PTED guided by MR navigation and X-ray fluoroscopy both achieves satisfactory results in the treatment of LDH,and MR navigation has higher safety and precision with minimally iatrogenic trauma.