经皮椎间孔内镜下椎间盘切除术中双三角定位法与传统定位法的对比研究

A comparative study of double triangle positioning and traditional positioning in percutaneous transforaminal endoscopic discectomy

中文关键词:  腰椎间盘突出症  经皮椎间孔内镜下椎间盘切除术  穿刺定位  双三角定位

英文关键词:Lumbar disc herniation  Percutaneous transforaminal endoscopic discectomy  Puncture positioning  Double triangle positioning

中文摘要:

  【摘要】 目的：提出一种应用于经皮椎间孔内镜下椎间盘切除术的定位法，比较其与传统定位法效果差异。方法：纳入2025年1月~2025年5月在我院骨科接受经皮椎间孔内镜下椎间盘切除术的腰椎间盘突出症患者65例，按穿刺定位方式分为两组，双三角定位组（33例）应用双三角定位法，传统组（32例）采用传统穿刺定位法。两组一般资料包括性别、年龄、基础病史（高血压、糖尿病、冠心病）、BMI、手术节段均无统计学差异（P＞0.05）。收集并比较两组间手术情况：穿刺置通道时间、透视次数、穿刺次数、总手术时间、术中Kolcaba舒适状况量表（general comfort questionnaire，GCQ）评分；术后2h通过视觉模拟（visual analogue scale，VAS）评分评估术区疼痛；统计术中不良事件及术后并发症情况。术前及术后1d、1个月及3个月进行腰痛VAS评分、腿痛VAS评分、Oswestry 功能障碍指数（Oswestry disability index，ODI）评定。结果：两组均顺利完成手术。双三角定位组穿刺置通道时间（14.73±2.34min）少于传统组（20.84±2.80min），透视次数（8.21±1.41次）少于传统组（13.50±1.98次），穿刺次数（2.18±1.07次）少于传统组（5.03±1.60次），总手术时间（59.58±2.46min）少于传统组（68.09±3.09min）（P<0.001）。术中GCQ评分双三角定位组（86.03±3.42分）优于传统组（83.88±3.51分）（P＜0.05）。术后2h术区疼痛VAS评分双三角定位组（2.59±1.22分）小于传统组（3.27±1.28分）。两组患者术后1d、1个月及3个月的腰痛、腿痛的VAS评分及ODI均较术前显著性改善（P＜0.001），两组间同时间点比较无统计学差异（P>0.05）。两组术中不良事件、术后并发症发生率无统计学差异（P>0.05）。结论：经皮椎间孔内镜下椎间盘切除术使用双三角定位法可有效减少穿刺置通道时间、X线透视次数、穿刺次数、总手术时间，降低术后2h术区疼痛，提高患者术中舒适度，且不会增加术中不良事件及术后并发症的发生率。

英文摘要:

  【Abstract】 Objectives: To propose a positioning method for percutaneous transforaminal endoscopic discectomy and compare its effectiveness with traditional positioning methods. Methods: 65 patients with lumbar disc herniation who underwent percutaneous transforaminal endoscopic discectomy in the Department of Orthopedics of our hospital between January 2025 to May 2025 were enrolled. The patients were divided into two groups based on puncture positioning methods: the double triangle positioning group(33 cases) using the double triangle positioning method and the traditional group(32 cases) using the traditional puncture positioning method. There were no statistical differences in general information between the two groups, including gender, age, underlying medical history(hypertension, diabetes, coronary heart disease), body mass index(BMI), and surgical level(P>0.05). The surgical conditions between the two groups were collected and compared, including puncture placement channel time, fluoroscopy frequency, puncture frequency, total operative time, intraoperative Kolcaba general comfort questionnaire(GCQ) scores; The postoperative pain in the surgical area was assessed using visual analogue scale(VAS) scores 2h after surgery; The intraoperative adverse events and postoperative complications were statistically analyzed. VAS scores for low back pain, VAS scores for leg pain, and Oswestry disability index(ODI) were assessed and recorded preoperatively and at 1d, 1 month, and 3 months postoperatively. Results: Both groups of patients successfully completed the surgery. The double triangle positioning group was less than the traditional group in the puncture placement channel time(14.73±2.34min vs 20.84±2.80min), fluoroscopy frequency(8.21±1.41 vs 13.50±1.98), number of puncture times(2.18±1.07 vs 5.03±1.60), and total operative time(59.58±2.46min vs 68.09±3.09min)(P<0.001). The intraoperative GCQ score in the double triangle positioning group(86.03±3.42) was improved than that of the traditional group(83.88±3.51)(P<0.05). The pain VAS scores in the surgical area within postoperative 2 hours in the double triangle positioning group(2.59±1.22) was less than that of the traditional group(3.27±1.28). The VAS scores for back pain and leg pain and ODI in both groups of patients showed significant improvement at postoperative day 1, month 1, and month 3 compared to preoperative levels(P<0.001), but there was no statistically significant difference between the two groups at any time point(P>0.05). No significant difference was observed in the incidence of intraoperative adverse events and postoperative complications between the two groups(P>0.05). Conclusions: In percutaneous transforaminal endoscopic discectomy, double triangle positioning method can effectively reduce puncture placement channel time, X-ray fluoroscopy frequency, puncture frequency, total operative time, and postoperative 2h pain VAS score in the surgical area, and significantly improve intraoperative comfort of patients, which does not increase the incidence of intraoperative adverse events and postoperative complications.