二维导航与X线透视引导经椎间孔入路内镜下椎间盘切除术治疗腰椎间盘突出症的对比研究

A comparative study of two-dimensional navigation and X-ray fluoroscopy-guided percutaneous endoscopic transforaminal discectomy in the treatment of lumbar disc herniation

中文关键词:  腰椎间盘突出症  二维导航  经椎间孔入路内镜下椎间盘切除术

英文关键词:Lumbar disc herniation  Two-dimensional navigation  Percutaneous endoscopic transforaminal discectomy

中文摘要:

  【摘要】 目的：比较二维导航与X线透视引导经椎间孔入路内镜下椎间盘切除术（percutaneous endoscopic transforaminal discectomy，PETD）治疗腰椎间盘突出症的早期临床效果。方法：回顾性分析2022年1月~2022年12月采用经椎间孔入路内镜下PETD治疗腰椎间盘突出症的患者80例。术中应用二维导航引导40例，纳入二维导航组，其中男24例，女16例，年龄28~55岁（40.5±7.7岁）；L3/4 10例，L4/5 18例，L5/S1 12例；术中采用X线透视引导40例，纳入X线透视组，其中男22例，女18例，年龄28~54岁（41.7±7.7岁）；L3/4 7例，L4/5 19例，L5/S1 14例。两组间年龄、性别、手术节段无统计学差异（P＞0.05）。随访11~16个月（13.3±1.2个月）。比较两组手术时间、术中出血量、术中透视次数及并发症发生情况，在术前、术后3d及术后12个月进行腿痛视觉模拟评分（visual analogue scale，VAS），在术前、术后1个月及术后12个月进行Oswestry功能障碍指数（Oswestry disability index，ODI）评定，术后12个月采用改良MacNab疗效评定标准评价临床疗效。结果：所有患者均顺利完成手术，二维导航组手术时间40.6±5.4min，术中出血量10.4±2.1mL，透视次数2.4±0.5次；X线透视组手术时间58.7±4.0min，术中出血量11.3±2.4mL，透视次数10.6±4.0次。二维导航组手术时间及透视次数低于X线透视组，差异有统计学意义（P<0.05）；两组出血量无统计学差异（P>0.05）。二维导航组有2例、X线透视组有3例术后出现短时间麻木感，发生率无统计学差异（P>0.05）。两组患者在术后各时间点腿痛VAS评分、ODI较术前明显降低，差异有统计学意义（P<0.05）。二维导航组术后3d腿痛VAS评分低于X线透视组，差异有统计学意义（P<0.05），其他随访时间点腿痛VAS评分和ODI均无统计学差异（P>0.05）。末次随访改良MacNab疗效评定：二维导航组优36例，良3例，可1例，优良率97.5%（39/40）；X线透视组优30例，良8例，可2例，优良率95%（38/40），两组优良率无统计学差异（P>0.05）。结论：二维导航与X线透视引导PETD治疗腰椎间盘突出症均能达到良好的临床效果，但二维导航引导PETD具有手术时间更短、透视次数更少的优势。

英文摘要:

  【Abstract】 Objectives: To compare the early clinical effects between the two-dimensional(2D) navigation and X-ray fluoroscopy-guided percutaneous endoscopic transforaminal discectomy(PETD) in the treatment of lumbar disc herniation(LDH). Methods: A retrospective analysis was conducted on 80 LDH patients who were treated with PETD from January 2022 to December 2022. 40 patients were treated with 2D navigation-guided PETD(2D navigation group), including 24 males and 16 females, aged 28-55 years(40.5±7.7 years); 10 cases were of L3/4, 18 cases were of L4/5, and 12 cases were of L5/S1. The other 40 patients were treated with X-ray fluoroscopy-guided PETD(X-ray fluoroscopy group), including 22 males and 18 females, aged 28-54 years(41.7±7.7 years); 7 cases were of L3/4, 19 cases were of L4/5, and 14 cases were of L5/S1. There were no statistical differences in age, gender, and surgical segment between the two groups(P>0.05). The patients were followed up for 11-16 months(13.3±1.2 months). The operation time, intraoperative bleeding volume, intraoperative fluoroscopy times, and complications of the two groups were analyzed. Visual analogue scale(VAS) scores of leg pain were evaluated before surgery, on 3d after operation, and at 12 months after surgery, and Oswestry disability index(ODI) was evaluated before surgery and at 1 month and 12 months after surgery. The clinical efficacy was evaluated using the modified MacNab efficacy evaluation criteria at 12 months after surgery. Results: All the patients successfully underwent the operation. The operation time in the 2D navigation group was 40.6±5.4min, the intraoperative bleeding volume was 10.4±2.1mL, and the fluoroscopy times were 2.4±0.5; The operation time in the X-ray fluoroscopy group was 58.7±4.0min, the intraoperative bleeding volume was 11.3±2.4mL, and the fluoroscopy times were 10.6±4.0. The operation time was less and fluoroscopy times were fewer in the 2D navigation group than those in the X-ray fluoroscopy group, and the differences were statistically significant(P<0.05). There was no statistical difference between the two groups in intraoperative bleeding(P>0.05). There were 2 cases in the 2D navigation group and 3 cases in the X-ray fluoroscopy group occurred short-term postoperative numbness, and the incidence was not statistically different between groups(P>0.05). The VAS scores of leg pain and ODI in both groups at various time points after surgery were significantly lower than those before surgery, and the differences were statistically significant(P<0.05). The VAS score of leg pain in the 2D navigation group was lower than that in the X-ray fluoroscopy group on 3d after surgery, and the difference was statistically significant(P<0.05). There were no significant differences between the two groups in VAS scores of leg pain and ODI at other time points during follow-up(P>0.05). The final follow-up modified MacNab efficacy evaluation: 36 cases were excellent, 3 cases were good, and 1 case was fair in the 2D navigation group, and the excellent and good rate was 97.5%(39/40); 30 cases were excellent, 8 cases were good, and 2 cases were fair in the X-ray fluoroscopy group, and the excellent and good rate was 95%(38/40), there was no statistical difference in the excellent and good rate between the two groups(P>0.05). Conclusions: Both 2D navigation and X-ray fluoroscopy-guided PETD can achieve good clinical results in treating LDH, and 2D navigation guided PETD needs shorter operation time and fewer fluoroscopy times.