摘要
目的:
通过对经皮穿刺操作进行透视观察研究,从而指导经皮穿刺手术步骤的操作;并比较经皮椎间孔镜(Percutaneous Transforaminal Endoscopic Discectomy,PTED)和显微内窥镜(Microendoscopic Discectomy,MED)在腰椎间盘切除术中的临床疗效。
方法:
1.制作穿刺模型,将椎间盘平面划分7个区域,对成人腰椎体标本穿刺定位后进行正侧位透视拍X线片,并分析研究穿刺针位于各个区域时的透视X线片。
2.采用前瞻性随机对照研究的方法,将2007年12月～2008年6月术前确诊为单节段腰椎间盘突出症的60例患者,随机分为PTED组和MED组,各30例。手术效果按照Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉类比评分(Visual analogue scale,VAS)和改良的MacNab标准评定。
结果:
1.通过研究得出各个区域的正侧位穿刺X线片的相关性,设计并制作《经皮穿刺定位软件》。
2.所有病例均顺利完成手术。两组病例的椎间盘突出类型,手术时间,术后随访时间,及并发症的发生率均无明显差异,但PTED组平均手术切口长度(0.7±0.2)cm,手术失血(7±2) ml,术后卧床(24±10)h,术后住院时间(3±1)d。MED组平均手术切口长度(1.9±0.3)cm,手术失血(48±13) ml,术后卧床(96±24)h,术后住院时间(7±2)d。按照改良的MacNab法评定优良率分别为90%和93%,两组无显著性差异(p>0.05)。PTED组和MED组术后ODI、VAS与术前比较,均明显改善(p<0.05)。
结论:
1.经皮穿刺技术在临床操作中有规律可循,借助C-型臂进行透视正侧位定位,参照经皮穿刺定位软件,能提高经皮穿刺的成功率和手术效率。
2. PTED和MED两种微创术式在治疗腰椎间盘突出症的短期结果均满意。在严格选择手术适应症的情况下,PTED具有切口小,出血少,创伤小和术后恢复快等微创优势,是一种安全有效的微创手术方法。
Objective:To investigate the the location of percutaneous puncture by radiographs, which can provide the useful data for the operation.And to compare the clinical effectiveness of percutaneous transforaminal endoscopic discectomy(PTED) with microendoscopic discectomy(MED).
Methods:
1. Desiding the vertebral puncture model ,and divide the surface of the disc into 7 regions.Taking the anterioposterior and lateral radiographs of the model to analyze the correlation of puncture needle’s radiographs in each region.
2. In this prospective randomized controlled study,a total of 60 patients preoperatively diagnosed as single lumbar disc herniation from December 2007 to June 2008,were randomly divided into two groups, 30 patients in each.The Oswestry disability index (ODI), Visual analogue scale (VAS), modified MacNab criteria were employed to measure the clinical outcomes.
Result:
1. There are some correlations between the anterioposterior and lateral radiographs. The percutaneous puncture location software are developed by the anterioposterior and lateral radiographs.
2. All the procedures were performed successfully.There was no significant difference between the two groups of disc herniation types,operative time, fellow-up time and complication rate. But the average skin incision of PTED was (0.7±0.2) cm, with an average blood loss was (7±2) ml and a mean postoperative stay of 1 day. The average skin incision of MED was (1.9±0.3)cm, with an average blood loss was (48±13) ml and a mean postoperative stay of nearly 4 days(range, 3～6days). According to the modified MacNab criteria, 90% of patients in PTED group showed excellent or good outcomes while 93% of patients in MED group showed excellent or good outcomes. There is no significant difference of between the the two groups(p>0.05). The improvement in VAS and ODI were statistically significant in the two groups (p<0.05).
Conclusion:
1. There some techniques in the process of percutaneous puncture step. By using C-arm and the software properly,the achievement ratio of puncture and the surgical efficiency will be improved.
2. According to the indications,the short surgical outcome of PTED for lumbar disc herniation is similar to MED, if the patients are selected strictly. But PTED has the advantages of smaller incision, less bleeding, less tissue trauma and quicker recovery. It is a safe and efficacious minimally invasive surgical technique.
引文
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