三维可视化虚拟手术系统联合椎间孔定位穿刺器在经皮内镜下经椎间孔减压手术治疗腰椎管狭窄症中的应用

Application of three-dimensional visual virtual surgery system combined with self-made intervertebral foramen positioning puncture device in percutaneous endoscopic transforaminal decompression of lumbar spinal stenosis

目的初步研究三维可视化虚拟手术系统联合自制椎间孔定位穿刺器在经皮内镜下经椎间孔减压手术治疗腰椎管狭窄症中的应用,评价这种方法建立通道的准确性、安全性及手术疗效。方法采用回顾性对照研究,选取在亳州市人民医院脊柱外科从2021年1-12月期间接受经皮内镜下经椎间孔减压手术治疗的64例腰椎管狭窄症患者,男27例,女37例,年龄(57.1±6.45)岁(范围50~77岁)。其中32例采用三维可视化虚拟手术系统联合自制椎间孔定位穿刺器方法建立通道(可视化组),32例采用传统常规方法建立通道(常规组)。分析两组住院天数、穿刺次数、穿刺时间、透视次数、手术时间,视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及并发症发生情况。结果所有患者都顺利完成手术和随访,无严重并发症发生。两组间一般资料、住院天数和手术时间比较差异无统计学意义(P>0.05)。可视化组在穿刺时间、穿刺次数和透视次数方面优于常规组,差异有统计学意义(P<0.05);两组术后VAS评分均优于术前,且差异均有统计学意义(P<0.05)。两组术后ODI均优于术前,且差异均有统计学意义(P<0.05)。结论三维可视化虚拟手术系统联合自制椎间孔定位穿刺器在经皮内镜下经椎间孔减压手术治疗腰椎管狭窄症中可以明显减少穿刺次数、透视次数和穿刺时间,穿刺准确性高、安全,手术效果满意,这种方法是可行的。

Objective This study aimed to preliminarily explore the application of three-dimensional visual virtual surgery system combined with self-made intervertebral foramen positioning puncture device in percutaneous endoscopic transforaminal decompression(PETD)of lumbar spinal stenosis(LSS)and to evaluate the accuracy,safety and surgical efficacy of this method.Methods A retrospective controlled study was conducted.From January 2021 to December 2021,64 patients(27 male and 37 female),aged(57.1±6.45)years,(range 50~77 years old)with LSS were treated by PETD.A three-dimensional visual virtual surgery system combined with self-made intervertebral foramen positioning puncture device was used to establish cannula in 32 patients(visualization group,V group),and traditional conventional methods were used to establish cannula in another 32 patients(routine group,R group).The hospitalization days,puncture times,puncture time,fluoroscopy times,operation time,visual analog score(VAS),Oswestry dysfunction index(ODI),and complications in the two groups were analyzed.Results The operation and follow-up were successfully completed in all patients without serious complications.There was no significant difference between two groups in terms of general information,hospitalization days and operation time(P>0.05).The V group was better than the R group in puncture time,puncture times and fluoroscopy times,and the differences were statistically significant(P<0.05).The VAS score of the two groups after operation was better than that before operation,and the difference was statistically significant(P<0.05).The ODI of the two groups after operation was better than that before operation,and the difference was statistically significant(P<0.05).Conclusions Through comparative research,this study showed that the three-dimensional visual virtual surgery system combined with self-made intervertebral foramen positioning puncture device could significantly reduce the puncture times,fluoroscopy times,and puncture time in the treatment of lumbar spinal stenosis using percutaneous endoscopic transforaminal decompression,with high puncture accuracy,safety,and satisfactory surgical effects.Therefore,the proposed method was feasible.