一种新型精准穿刺定位装置的研制及应用

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (8655 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的研制一种新型穿刺定位装置，评价其在辅助腰椎椎间孔镜手术穿刺定位的应用价值。方法腰椎三维空间可构建一个直角三角形，其斜边为后外侧入路理想穿刺路径，根据该原理研制一种穿刺定位装置辅助手术。2020年6月至2021年4月在梧州市红十字会医院骨科诊断为单节段腰椎间盘突出症并行经皮椎间孔镜手术的患者64例，其中男34例，女30例；年龄22~79岁，平均(55.15±16.42)岁。将患者随机分为穿刺定位装置组与利用C型臂透视下徒手完成穿刺定位的传统组，其中装置组34例，传统组30例。比较两组患者穿刺次数、穿刺时间、透视次数以及术前、术后特定时间疼痛视觉模拟评分(visual analogue scale，VAS)、日本骨科协会(Japanese orthopaedic association，JOA)评分以及Oswestry功能障碍指数(Oswestry disability index，ODI)。结果定位装置组的穿刺次数、穿刺时间、透视次数均小于传统组，差异有统计学意义(P＜0.05)。两组患者术后1 d、术后6个月的JOA评分及ODI指数较术前显著改善(P＜0.05)；两组VAS评分、JOA评分及ODI指数比较，差异无统计学意义(P＞0.05)。结论直角三角形测量法可作为新的术前设计方法；腰椎椎间孔镜手术应用本新型穿刺定位装置可减少穿刺次数及时间，提高准确率，尤适用于初学者。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李国栋
	卓斯敏
	潘式新
	盘景伟
	李泉
	何恩谋
	杨龙
	甘秀天

关键词 ：腰椎间盘突出症, 椎间孔镜, 穿刺定位, 辐射损伤, 临床应用

Abstract：Objective To develop a novel puncture localization device and evaluate its application value in assisting puncture localization in lumbar intervertebral foramen surgery.Methods A right triangle can be constructed in the three-dimensional space of the lumbar spine，and the hypotenuse was that the ideal puncture path for the posterolateral approach.According to this principle，a puncture positioning device was developed to assist surgery.From June 2020 to April 2021，there were 64 patients diagnosed with single segment lumbar disc herniation and underwent percutaneous transforaminal surgery in the orthopedic department of Wuzhou Red Cross Hospital，including 34 males and 30 females.The age range was 22~79 years，with an average of (55.15±16.42) years old.Patients were randomly divided into a puncture positioning device group and a traditional group that completed puncture positioning with freehand technqiue under C-arm fluoroscopy.Among them，the device group had 34 cases and the traditional group had 30 cases.We compare the puncture frequency，puncture time，fluoroscopy frequency，visual analogue scale(VAS) pain score，Japanese Orthopaedic Association (JOA) score，and Oswestry Disability Index (ODI) of two groups of patients at specific times before and after surgery.Results The puncture frequency，puncture time，and fluoroscopy frequency of the positioning device group were all lower than those of the traditional group，with a statistically significant difference (P＜0.05).The JOA score and ODI index of the two groups of patients improved significantly at 1 day and 6 months after surgery compared to before surgery (P＜0.05)；There was no statistically significant difference in VAS score，JOA score，and ODI index between the two groups (P＞0.05).Conclusion Right triangle measurement can be used as a new preoperative design method.The application of this new puncture positioning device in lumbar intervertebral foramen endoscopic surgery can reduce the number and time of punctures，improve accuracy，and is particularly suitable for beginners.

Key words： lumbar disc herniation intervertebral foraminal endoscopy puncture location radiation injury clinical application

基金资助:梧州市科技计划项目(202002141)
实用新型专利：一种椎间孔镜穿刺定位装置(CN 211796766 U)

通讯作者: 甘秀天

作者简介: 李国栋(1986－ )，男，副主任医师，梧州市红十字会医院骨一科，362860284@qq.com

引用本文:

李国栋，卓斯敏，潘式新，盘景伟，李泉，何恩谋，杨龙，甘秀天. 一种新型精准穿刺定位装置的研制及应用[J]. 实用骨科杂志, 2023, 29(6): 515-.
Li Guodong，Zhuo Simin，Pan Shixin，Pan Jingwei，Li Quan，He Enmou，Yang Long，Gan Xiutian. Application of a New Positioning and Puncture Device for Percutaneous Endoscopic Lumbar Discectomy. sygkzz, 2023, 29(6): 515-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I6/515

［1］Liu X，Yuan S，Tian Y，et al.Comparison of percutaneous endoscopic transforaminal discectomy，microendoscopic discectomy，and microdiscectomy for symptomatic lumbar disc herniation：minimum 2year follow-up results［J］.Neurosurg Spine，2018，28(3)：317-325.
［2］Ahn SS，Kim SH，Kim DV，el al.Comparison of outcomes ofperculaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults：A retrospective matched cohort study［J］.World Neurosurg，2016(86)：250-258.
［3］Mehren C，Wanke-Jellinek L.Posterior foraminotomy for lateral cervical disc herniation［J］.Eur Spine J，2019，28(Suppl 1)：1-2.
［4］Ao S，Wu J，Zheng W，et al.A novel largeledforaminoplasty device improves the efficacy and safety of foraminoplasty in pereulaneous endoscopic lumbar discectomy：Preliminary clinieal application of 70 ceases［J］.World Neurosurg，2018(115)，e263-e271.
［5］Wu R，Liao X，Xia H.Radiation exposure to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy：Aprospective study［J］.World Neurosurg，2017，101(5)：658-665.
［6］Fan G，Han R，Gu X，et al.Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy［J］.Int Orthop，2017，41(2)：323-332.
［7］田伟，陈伯华.腰椎间盘突出症诊疗指南［J］中华骨科学杂志，2020，40(8)：477-487.
［8］Heider FC，Mayer HM.Surgical treatment of lumbar disc herniation［J］.Oper Orthop Traumatol，2017，29(1)：59-85.
［9］Schbert M，Hoogland T.Endoscopictransforaminalnucleotomy with foraminoplasty for lumbar disk herniation［J］.Oper Orthop Traumatol，2005，17(6)：641-661.
［10］白一冰.椎间孔镜BEIS技术操作规范［M］.北京：人民卫生出版社，2015：83.
［11］李长青，周跃，王建，等.经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症［J］.中国脊柱脊髓杂志，2013，23(3)：193-197.
［12］Ashley EA.Towards precision［J］.Nat Rev Genet，2016，17(9)：507-522.
［13］Collins FS，Varmus H.A new initiative on precision medicine［J］.N Engl J Med，2015，372(9)：793-795.
［14］Mahesha K.Percutaneous endoscopic lumbar discectomy results of first 100 cases［J］.Indian J Orthop，2017，51(1)：36-42.
［15］Zeng Y，Bao J，Su J，et al.Novel targeted puncture technique for percutaneous transforaminal endoscopic lumbar discectomy reduces X-ray exposure［J］.ExpTher Med，2017，14(4)：2960-2968.
［16］Choi G，ModiHN，Prada N，et al.Clinical results of XMR-assisted percutaneoustransforaminal endoscopic lumbar discectomy［J］.Orthop Surg Res，2013，8(1)：14.
［17］Liu YB，Wang Y，Chen ZQ，et al.Volume navigation with fusion of real-time ultrasound and ct images to guide posterolateral transforaminal puncture in percutaneous endoscopic lumbar discectomy［J］.Pain Physician，2018，21(3)：E265-E278.
［18］刘维克，夏乐，杨同岗，等.骨科手术机器人在个体化椎间孔镜穿刺导向中的应用［J］.颈腰痛杂志，2020，41(4)：389-391.
［19］Ajiboye RM，Koltsov JCB，Karamian B，etal.Computerassisted surgical navigation is associated wih an increased risk of neurological complications：A review of 67，264 posterolateral lumbar fusion cases［J］.Spine Surg，2019，5(4)：457-465.
［20］Fomekong E，Pierrard J，Raftopoulos C.Comparative cohort study of percutaneous pedicle screw implantation without versus with navigation in patients undergoing surgery for degenerative lumbar disc disease［J］.World Neurosurg，2018(111)：e410-e417.
［21］Luenam S，Kosiyatrakul A，Hansudewechakul C，el al.The patient-specific implant created with 3D printing technology in treatment of the irreparable radial head in chronic persistent elbow instability［J］.Case Rep Orthop，2018(2018)：9272075.