偏心导杆结合可视化椎间孔成形技术在腰椎间盘切除术中的临床应用

目的 探讨偏心导杆结合可视化椎间孔成形技术在经皮内镜下腰椎间盘切除术(PELD)中的临床应用价值。方法 回顾性分析2017年1—10月河北医科大学第三医院脊柱外科采用PELD治疗腰椎间盘突出症患者的临床资料。其中男15例,女15例;年龄39～61(48.57±5.91)岁。病变部位:L_4～5 17例, L₅～S₁ 13例。按手术方式不同分为TESSYS组和I see组:采用椎间孔入路脊柱内镜系统技术15例纳入TESSYS组,采用偏心导杆结合可视化椎间孔成形技术15例纳入I see组。比较两组患者导管置入时间、术中放射线暴露时间、减压操作时间、上关节突切除率,术前、术后即刻及术后3、6、12个月腰、腿部视觉模拟评分(VAS)、Oswertry功能障碍指数(ODI)、日本骨科协会(JOA)评分,以及术后12个月MacNab标准评定的疗效。结果 两组患者均顺利完成手术。I see组的导管置入时间和术中放射线暴露时间分别为(16.73±2.46)min、(38.15±5.72)s,均少于TESSYS组的(19.87±3.79)min、(49.79±7.40)s;I see组上关节突切除率为32.25%±1.12%,大于TESSYS组的12.02%±0.67%:差异均有统计学意义(t=2.682、4.820、38.890,P值均＜0.05)。两组术中减压操作时间差异无统计学意义(P＞0.05)。两组组内比较:术后不同时间腰、腿痛的VAS以及ODI均比术前减少,JOA评分均比术前增加,差异均有统计学意义(F_{I see组}=167.298、268.815、7 271.864、316.342,F_TESSYS组=168.759、341.300、1 368.354、141.090,P值均＜0.01)。I see组与TESSYS组比较:术后不同时间腰、腿痛的VAS、ODI、JOA评分差异均无统计学意义(P值均＞0.05)。术后12个月采用MacNab评定标准评定疗效,I see组优8例、良4例、可3例,TESSY组优7例、良6例、可6例,两组间比较差异无统计学意义(Z=0.114,P＞0.05)。结论 对于腰椎间盘突出症,偏心导杆结合可视化椎间孔成形技术是一个有效且安全的椎间孔成形方法;采用该技术行PELD,可获得与TESSYS技术相同的疗效,同时减少术中导管置入时间、放射线暴露时间、上关节突切除率。

Clinical application of visualization foraminoplasty with off-center rod

Objective To evaluate clinical application value of percutaneous endoscopic lumbar decompression (PELD) by visualization foraminoplasty with off-center rod.Methods The clinical data of 30 patients from the Third Hospital of Hebei Medical University with lumbar degenerative disease who underwent transforaminal endoscopic spine system (TESSYS group,15) and visualization foraminoplasty with off-centered rod (I see group,15) separately were retrospectively reviewed and selected, including 15 males and 15 females with an age of 39-61(48.57±5.91) years. Among them, the lesion spine level was located at L_4-5 segment in 17 patients and L₅-S₁ in 13 patients. The catheter placement time, intraoperative radiation exposure time, decompression time, and superior articular process removal rate were compared between the two groups. visual analog scale(VAS), Oswestry disability index(ODI) and Japanese Orthopedics Association(JOA) scores of waist and leg were compared before and immediately after surgery and 3, 6 and 12 months after surgery. MacNab was used to evaluate the efficacy 12 months after the operation.Results The operation was performed successfully for all patients. The catheter placement time and intraoperative radiation exposure time in the I see group were (16.73±2.46) min and (38.15±5.72) s, respectively, which were significantly lower than those in TESSYS group (19.87±3.79) min and (49.79±7.40) s, respectively]. The percentage of superior articular process resection in the I see group was 32.25%±1.12%, which was higher than that in the TESSYS group (12.02%±0.67%). The differences were statistically significant (t=2.682, 4.820, 38.890, all P values＜0.05). There was no significant difference in intraoperative decompression time between the two groups (P＞0.05). In the two groups, VAS and ODI of lumbar and leg pain at different postoperative time were significantly decreased, and JOA score was significantly increased compared with that before surgery, with statistically significant differences (F_{I see group}=167.298, 268.815, 7271.864, 316.342, F_{TESSYS group}=168.759, 341.300, 1368.354, 141.090, all P values＜0.05).Compared the I see group with the TESSYS group, VAS, ODI and JOA scores of lumbago and leg pain at different postoperative time were not statistically significant(all P values＞0.05). Twelve months after the operation, MacNab evaluation criteria were used to evaluate the efficacy. There were 8 excellent cases, 4 good cases and 3 acceptable cases in the I see group, and 7 excellent cases, 6 good cases and 6 acceptable cases in the TESSY group. The difference between the two groups was not statistically significant (Z=0.114, P＞0.05).Conclusions For lumbar disc herniation, off-center rod with ISEE is a safe and effective foraminoplasty. It can reduce intraoperative radiation frequency, minimize the intraoperative radiation exposure and increase the superior articular process resection rate.