电磁导航辅助经椎间孔入路经皮内窥镜下腰椎椎间盘切除术治疗腰椎椎间盘突出症

Electromagnetic navigation assisted percutaneous endoscopic transforaminal discectomy for lumbar disc herniation

目的探讨电磁导航技术应用于经椎间孔入路经皮内窥镜下腰椎椎间盘切除术(PETD)治疗腰椎椎间盘突出症(LDH)的安全性、准确性和可行性。方法回顾性分析2019年4月—2021年4月采用电磁导航辅助PETD治疗的L4/L5节段LDH患者37例,记录住院时间、住院费用及并发症发生情况,记录手术时间以分析该技术学习曲线。分别于术前、术后1 d和末次随访时采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评估腰腿痛程度和腰椎功能;采用健康调查简表(SF-36)评分评估患者生活质量;术后采用改良MacNab标准评定手术疗效满意度,并分析满意度为优与各项评估指标之间的相关性。结果所有手术顺利完成,无术中转为开放手术病例,患者随访时间>12个月。所有患者术后VAS评分、ODI较术前明显改善,且末次随访时较术后1 d进一步改善,差异均有统计学意义(P<0.05)。术后SF-36评分8个维度评分较术前明显改善,差异均有统计学意义(P<0.05)。改良MacNab标准评定疗效满意度,优27例,良6例,可4例,优良率为89.2%;满意度为优与各项评估指标之间未发现相关性。结论电磁导航辅助PETD治疗LDH安全、有效、准确、微创,提高了穿刺和减压的安全性,减少了辐射暴露及并发症的发生,其临床疗效不受患者人口学特征和术前腰腿痛程度的影响。

Objective To investigate the safety,accuracy and feasibility of electromagnetic navigation technolgoy applied to percutaneous endoscopic transforaminal discectom(y PETD)for lumbar disc herniatio(n LDH).Methods From April 2019 to April 2021,37 patients with single-segment LDH treated by electromagnetic navigation assisted PET Dwere retrospectively analyzed.The hospital stay,hospitalization cost and complications were recorded,and the operation time was recorded to analyze the learning curve of this technology.The visual analgoue scal(e VAS)score and Oswestry disability inde(xODI)were used to evaluate the intensity of low back and leg pain and lumbar function at pre-operation,postoperative 1 d and the final follow-up.The MOS 36-item short from health surve(ySF-36)score was used to evaluate the quality of life.The modifi ed MacNab criteria was used to evaluate the satisfaction degree otfheraputic effect,and the correlation between the satisfactio n and each evaluation index was analyzed.Results All the operations were successfully completed,and no cases were converted to open operation intraoperatively.All the patients were follwoed up for more than 12 months.The VAS score and ODI of a ll the patients were significantly improved after operation compared iwth those before operation,and were further improved at the final follow-up compared with postoperative 1 d,and the differences were statistically significa(ntP<0.05).All the 8 dimensions of SF-36 score were significantly improved compared with those befor eoperation,and the differences were statistically significant(P<0.05).According to the modified MacNab criteria,theraputic effect was excellent in 27 cases,good in 6 and fair in 4,with an excellent and good rate of 89.2%.No correlation was ufnod between satisfactory and each evaluation index.Conclusion Electromagnetic navigation assisted PETD for LDH is safe,effective,accurate and minimally invasive,which improves the safety of puncture and decompression,reduces radiation exposure and complications,and its clinical efficacy is not affected by the demographic characteristics of patients and the intensity of preoperative low back and leg pain.