基于3D slicer比较两种椎间孔成型方法对上关节突的影响

目的比较骨钻和环锯在椎间孔成型中切除上关节突体积和部位的差异,评估两种成型方法对腰椎稳定性的影响。方法采用前瞻性队列研究的方法,对2021年5月至2022年7月行经皮椎间孔镜腰椎间盘摘除术的单节段腰椎间盘突出症60例患者的临床及影像学资料进行分析,术前通过电脑进行随机分组,其中骨钻30例,环锯30例。采用3D Slicer软件对术前及术后的上关节突进行建模,比较切除体积及部位的差异。结果骨钻切除上关节突的体积显著少于环锯[(175.81±88.49)mm^(3)VS.(558.80±232.22)mm^(3),P<0.05]。骨钻容易磨除上关节突的腹侧,而环锯更易切除上关节突的尖端[χ^(2)=36.667,P<0.001]。结论骨钻磨除上关节突体积较少且主要磨除腹侧,对腰椎稳定性的影响小;环锯切除上关节突体积较多且容易切除尖端,对腰椎稳定性的影响大。盲视成型时应尽量选择使用骨钻进行成型。

Objective To compare the differences in volume and site of resected superior articular processes between bone reamer and trephine in foraminoplasty and to assess the effects of both methods of foraminoplasty on lumbar spine stability.Methods A prospective cohort study was used to analyze the clinical and imaging data of 60 patients with single-segment lumbar disc herniation who underwent percutaneous foraminoplasty for lumbar disc removal from May 2021 to July 2022,with preoperative randomization by computerized grouping of 30 patients with bone reamer and 30 patients with trephine.The 3D Slicer software was used to model the preoperative and postoperative superior articular process,and the differences in resection volume and site were compared.Result The volume of the superior articular process resected by the bone reamer was significantly less than that by the trephine[(175.81±88.49)mm^(3)VS.(558.80±232.22)mm^(3),P<0.05].The ventral aspect of the superior articular process was easily removed with the bone reamer,while the tip of the superior articular process was more easily removed with the trephine[χ^(2)=36.667,P<0.001].Conclusion The bone reamer has less impact on the stability of the lumbar spine by removing less volume of the superior articular process and mainly the ventral side,while the trephine has more volume of the superior articular process and is more likely to remove the tip,which has a greater impact on the stability of the lumbar spine.The bone reamer should be used for blind molding as much as possible.