| 秦豪,黄文华,杨克勤,江建中,黄圣斌,谢兆林,罗翔,谭海涛.计算机导航技术辅助定位穿刺行经椎间孔入路经皮内窥镜下椎间盘切除术[J].脊柱外科杂志,2020,18(5):293-299. |
计算机导航技术辅助定位穿刺行经椎间孔入路经皮内窥镜下椎间盘切除术  点此下载全文 (Fulltext) |
| 秦豪1 黄文华2 杨克勤1 江建中1 黄圣斌1 谢兆林1 罗翔1 谭海涛1* |
1. 贵港市人民医院骨科, 贵港 537100;
2. 南方医科大学基础医学院国家重点学科人体解剖学教研室, 广州 510515 |
| 基金项目：国家重点研发计划项目（2017YFC1103400）；广西科技计划项目（桂科AD17129017，桂科AD17195042）；广东省省级科技计划项目（2016B090917001）；贵港市科学研究与技术开发计划项目（贵科通1834002，贵科转1803002） |
| DOI：10.3969/j.issn.1672-2957.2020.05.002 |
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| 摘要： |
| 目的 比较计算机导航技术辅助定位穿刺和常规定位穿刺行经椎间孔入路经皮内窥镜下椎间盘切除术（PETD）治疗腰椎椎间盘突出症（LDH）的临床疗效。方法 2018年10月—2019年4月，贵港市人民医院采用PETD治疗LDH患者70例，根据穿刺方法分为计算机导航辅助定位穿刺组（导航组）和常规定位穿刺组（常规组），每组35例。记录并比较2组手术时间、透视时间、透视次数、穿刺时间、穿刺次数及并发症发生情况。采用疼痛视觉模拟量表（VAS）评分评估2组患者腰部及下肢疼痛情况，采用日本骨科学会（JOA）评分和Oswestry功能障碍指数（ODI）评估术后功能恢复情况。结果 所有手术顺利完成。导航组手术时间、透视时间、透视次数、穿刺时间、穿刺次数均少于常规组，差异有统计学意义（P < 0.05）。2组术后腰痛VAS评分、下肢痛VAS评分、JOA评分及ODI均较术前显著改善，差异有统计学意义（P < 0.05），组间比较差异无统计学意义（P > 0.05）。导航组术后出现LDH复发2例、脱出椎间盘残留2例，常规组术后出现LDH复发2例、脱出椎间盘残留4例，根据严重程度行非手术或再次手术治疗后症状均缓解。Pearson相关分析显示，透视次数、透视时间、穿刺次数、穿刺时间及手术时间之间存在高度相关性。结论 计算机导航技术辅助定位穿刺行PETD可减少透视和穿刺的次数和时间，进而减少手术时间及降低医患的辐射暴露，值得临床推广。 |
| 关键词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术,经皮 外科手术,微创性 计算机辅助设计 |
| Computer navigation technique assisted localization puncture for percutaneous endoscopic transforminal discectomy Fulltext |
| QIN Hao1 HUANG Wen-hua2 YANG Ke-qin1 JIANG Jian-zhong1 HUANG Sheng-bin1 XIE Zhao-lin1 LUO Xiang1 TAN Hai-tao1* |
1. Department of Orthopaedics, Guigang People's Hospital, Guigang 537100, Guangxi Zhuang Autonomous Region, China;
2. Department of National Key Discipline of Human Anatomy, Basic Medical College, Southern Medical University, Guangzhou 510515, Guangdong, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical efficacy of percutaneous endoscopic transforminal discectomy（PETD） by using computer navigation technique and conventional positioning puncture for the treatment of lumbar disc herniation（LDH）. Methods From October 2018 to April 2019，70 patients with LDH treated by PETD in Guigang People's Hospital were divided into 2 groups：computer navigation assisted location puncture group（navigation group） and conventional location puncture group（convention group），35 cases in each group. The operation time，fluoroscopy time，fluoroscopy frequency，puncture time，puncture frequency and complications of the 2 groups were recorded and compared. Visual analogue scale（VAS） score was used to assess the pain in the low back and lower limbs of the 2 groups. Japanese Orthopaedic Association（JOA） score and Oswestry disability index（ODI） were used to evaluate the postoperative functional improvement. Results All the operations were completed successfully. The operation time，fluoroscopy time，fluoroscopy frequency，puncture time，puncture frequency in the navigation group were less than those in the convention group，all with a statistically significant difference（P < 0.05）. The postoperative VAS scores of low back and lower limbs，JOA scores and ODI in the 2 groups were significantly improved compared with those before operation，all with a statistically significant difference（P < 0.05），and there was no statistically significant difference between the 2 groups（P > 0.05）. In the navigation group，postoperative LDH recurred in 2 cases and prolapse intervertebral disc residue in 2. In the convention group，postoperative LDH recurred in 2 and prolapse intervertebral disc residue in 4. According to the severity of complications，the symptoms were relieved after non-surgical treatment or reoperation. Pearson correlation analysis showed that there was a high correlation between the fluoroscopy time，fluoroscopy frequency，puncture time，puncture frequency and the operation time. Conclusion PETD can reduce the frequency and time of fluoroscopy and puncture，thus reducing the operation time and radiation exposure of medical staff and patients and worthy of clinical promotion. |
| Keywords:Lumbar vertebrae Intervertebral disc displacement Endoscopy Diskectomy,percutaneous Surgical procedures,minimally invasive Computer-aided design |
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