BACKGROUND The coaxial radiography-guided puncture technique(CR-PT)is a novel technique for endoscopic lumbar discectomy.As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction,t...BACKGROUND The coaxial radiography-guided puncture technique(CR-PT)is a novel technique for endoscopic lumbar discectomy.As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction,the X-ray beam can be used to guide the trajectory angle,facilitating the choice of the puncture site and providing real-time guidance.This puncture technique offers numerous advantages over the conventional anterior-posterior and lateral radiography-guided puncture technique(AP-PT),especially in cases of herniated lumbar discs with a hypertrophied transverse process or articular process,high iliac crest,and narrowed intervertebral foramen.AIM To confirm whether CR-PT is a superior approach to percutaneous transforaminal endoscopic lumbar discectomy compared to AP-PT.METHODS In this parallel,controlled,randomized clinical trial,herniated lumbar disc patients appointed to receive percutaneous endoscopic lumbar discectomy treatment were recruited from the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University and Nantong Hospital of Traditional Chinese Medicine.Sixty-five participants were enrolled and divided into either a CR-PT group or an AP-PT group.The CR-PT group underwent CR-PT,and the AP-PT group underwent AP-PT.The number of fluoroscopies during puncturing,puncture duration(min),surgery duration(min),VAS score during puncturing,and puncture success rate were recorded.RESULTS Sixty-five participants were included,with 31 participants in the CR-PT group and 34 in the AP-PT group.One participant in the AP-PT group dropped out due to unsuccessful puncturing.The number of fluoroscopies[median(P25,P75)]was 12(11,14)in the CR-PT group vs 16(12,23)in the AP-PT group,while the puncture duration(mean±SD)was 20.42±5.78 vs 25.06±5.46,respectively.The VAS score was 3(2,4)in the CR-PT group vs 3(3,4)in the AP-PT group.Further subgroup analysis was performed,considering only the participants with L5/S1 segment herniation:9 patients underwent CR-PT,and 9 underwent AP-PT.The number of fluoroscopies was 11.56±0.88 vs 25.22±5.33;the puncture duration was 13.89±1.45 vs 28.89±3.76;the surgery duration was 105(99.5,120)vs 149(125,157.5);and the VAS score was 2.11±0.93 vs 3.89±0.6,respectively.All the above outcomes demonstrated statistical significance(P<0.05),favoring the CR-PT treatment.CONCLUSION CR-PT is a novel and effective technique.As opposed to conventional AP-PT,this technique significantly improves puncture accuracy,shortens puncture time and operation time,and reduces pain intensity during puncturing.展开更多
文摘BACKGROUND The coaxial radiography-guided puncture technique(CR-PT)is a novel technique for endoscopic lumbar discectomy.As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction,the X-ray beam can be used to guide the trajectory angle,facilitating the choice of the puncture site and providing real-time guidance.This puncture technique offers numerous advantages over the conventional anterior-posterior and lateral radiography-guided puncture technique(AP-PT),especially in cases of herniated lumbar discs with a hypertrophied transverse process or articular process,high iliac crest,and narrowed intervertebral foramen.AIM To confirm whether CR-PT is a superior approach to percutaneous transforaminal endoscopic lumbar discectomy compared to AP-PT.METHODS In this parallel,controlled,randomized clinical trial,herniated lumbar disc patients appointed to receive percutaneous endoscopic lumbar discectomy treatment were recruited from the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University and Nantong Hospital of Traditional Chinese Medicine.Sixty-five participants were enrolled and divided into either a CR-PT group or an AP-PT group.The CR-PT group underwent CR-PT,and the AP-PT group underwent AP-PT.The number of fluoroscopies during puncturing,puncture duration(min),surgery duration(min),VAS score during puncturing,and puncture success rate were recorded.RESULTS Sixty-five participants were included,with 31 participants in the CR-PT group and 34 in the AP-PT group.One participant in the AP-PT group dropped out due to unsuccessful puncturing.The number of fluoroscopies[median(P25,P75)]was 12(11,14)in the CR-PT group vs 16(12,23)in the AP-PT group,while the puncture duration(mean±SD)was 20.42±5.78 vs 25.06±5.46,respectively.The VAS score was 3(2,4)in the CR-PT group vs 3(3,4)in the AP-PT group.Further subgroup analysis was performed,considering only the participants with L5/S1 segment herniation:9 patients underwent CR-PT,and 9 underwent AP-PT.The number of fluoroscopies was 11.56±0.88 vs 25.22±5.33;the puncture duration was 13.89±1.45 vs 28.89±3.76;the surgery duration was 105(99.5,120)vs 149(125,157.5);and the VAS score was 2.11±0.93 vs 3.89±0.6,respectively.All the above outcomes demonstrated statistical significance(P<0.05),favoring the CR-PT treatment.CONCLUSION CR-PT is a novel and effective technique.As opposed to conventional AP-PT,this technique significantly improves puncture accuracy,shortens puncture time and operation time,and reduces pain intensity during puncturing.
文摘0—2度脊椎前滑脱基本无明显症状，但是随着时间推移以及出现的一些影响背痛的因素，从而导致慢性下腰痛。标准的治疗方法为物理治疗和激素等非手术治疗，但有些患者因效果不佳需要手术治疗。Aunoble S等介绍一种治疗0—2度脊椎前滑脱症的新技术：视频辅助下前路椎间融合和固定。选择慢性下腰痛2年以上并经非手术治疗效果不佳的20例患者，记录临床信息和根性痛情况。术前和术后（直至随访结束）应用Oswestry评分和可视性评分（visual analog score VAS）对腿痛和腰痛进行评估。X线平片提示0度滑脱8名、1度滑脱10名、2度滑脱2名（根据Meyerding分类法）。所有病例手术途径均为前路视频辅助下经腹膜后途径，行椎间盘摘除术、植入前路椎间融合器（填塞自体髂嵴松质骨）、以及三角锥形钢板固定。在分别3个月、6个月、12个月和24个月后对患者的临床和影像学情况进行评估。结果：11例女性和9例男性，平均年龄39岁，BMI为25．6岁。所有患者的向前滑脱部位均在L5，平均滑移19％，7例L5椎体变异。失血量低于100ml。所有患者术后均给予8周的腰围固定。男性患者均未出现逆行射精，女性也未出现性功能异常。1例2度滑脱的患者疼痛无明显缓解，再手术行腰后路椎弓根螺钉固定。在2年的随访中有19例患者取得良好的融合（95％），Oswestry平均评分从术前的74％提高到术后随访结束时的21％，腰痛的可视性评分从6．5提高到2．7，而腿痛的评分是从6．2到3．4。在平均5．5个月内（6周到1年）有18例患者回到了工作岗位。结论：与后路椎间融合和固定技术相比，本技术的并发症发生率更低，而疗效相似。但2度以上滑脱患者似乎不太适合于本技术。从研究中可以看到本技术的主要优点在于避免了腰后背肌肉的损伤以及减少失血量而有利于术后恢复。
