数字3D技术辅助经皮椎间孔镜椎间盘切除术治疗退行性腰椎管狭窄

3D Digital Technique Assisted Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Degenerative Lumbar Spinal Stenosis

目的比较数字3D技术辅助经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)与传统PTED治疗退行性腰椎管狭窄(degenerative lumbar spinal stenosis,DLSS)的临床效果。方法回顾性分析2016年4月~2019年10月我科114例PTED的临床资料,采用3D技术辅助PTED 55例(观察组),传统PTED 59例(对照组),比较2组建立通道时间、神经根减压时间、术中出血量、并发症,术前、术后3个月、6个月、末次随访下肢痛视觉模拟评分(Visual Analogue Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)以及末次随访疗效(改良MacNab标准)。结果2组均顺利完成手术,观察组建立通道时间(10.5±2.5)min,明显短于对照组(12.8±3.5)min(t=-4.018,P=0.000)。观察组神经根减压时间(44.5±9.8)min,对照组(45.0±8.5)min,2组比较无统计学差异(t=-0.256,P=0.798)。观察组术中出血量(15.1±3.0)ml,对照组(14.4±2.6)ml,2组比较无统计学差异(t=1.306,P=0.194)。对照组1例行走根损伤,1例术后切口红肿。观察组随访(13.9±3.6)月,对照组(14.6±1.8)月,2组比较差异无显著性(t=-1.370,P=0.171)。2组术后3个月、6个月、末次随访VAS评分及ODI均较术前明显改善(均P=0.000),2组间差异无统计学意义(F=0.234,P=0.630;F=0.295,P=0.588)。末次随访2组改良MacNab标准优良率差异无统计学意义[96.4%(53/55)vs.94.9%(56/59),χ^(2)=0.142,P=0.706]。结论数字3D技术辅助PTED与传统PTED治疗DLSS安全、有效,数字3D技术辅助PTED可优化手术操作,缩短手术时间。

Objective To compare clinical effects of 3D digital technique assisted percutaneous transforaminal endoscopic discectomy(PTED)and traditional PTED in the treatment of degenerative lumbar spinal stenosis.Methods Clinical effects of 114 PTED cases from April 2016 to October 2019,including 55 cases of 3D digital technique assisted PTED(observation group)and 59 cases of traditional PTED(control group),were analyzed.The time of channel establishment,decompression time,intraoperative blood loss,complications,visual analogue scale(VAS)of lower limb pain and Oswestry disability index(ODI)before surgery,3 months after surgery,6 months after surgery,and at the last follow-up,and efficacy at the last follow-up(modified MacNab criteria)were taken as main indicators of clinical effects.Results The operations were successfully completed in both groups.The channel establishment time in the observation group was(10.5±2.5)min,which was significantly shorter than that in the control group(12.8±3.5)min(t=-4.018,P=0.000).The nerve root decompression time of observation group and control group were(44.5±9.8)min and(45.0±8.5)min,respectively,which showed no significant difference(t=-0.256,P=0.798).The intraoperative blood loss in the observation group(15.1±3.0)ml and the control group(14.4±2.6)ml was close(t=1.306,P=0.194).There were 1 case of walking root injury and 1 case of incision infection in the control group.The observation group was followed up for(13.9±3.6)months,and the control group was followed up for(14.6±1.8)months,which showed no significant difference(t=-1.370,P=0.171).The VAS score and ODI of the two groups were significantly improved in the 3 months,6 months and at the last follow-up as compared with those before operation(all P=0.000),and there were no statistical differences between the two groups(F=0.234,P=0.630;F=0.295,P=0.588).At the last follow-up,there was no significant difference in the excellent and good rates between the two groups[96.4%(53/55)vs.94.9%(50/59),χ^(2)=0.142,P=0.706].Conclusions Both 3D digital technique assisted PTED and traditional PTED are safe and effective surgical methods for degenerative lumbar spinal stenosis.3D digital technique can shorten the surgical time and optimize the surgical process.