导航导杆在椎间孔镜穿刺定位的应用

Application of navigation rod for puncture and positioning in percutaneous endoscopic lumbar discectomy

中文关键词:  导航导杆  椎间孔镜  穿刺定位  椎间盘突出

英文关键词:Navigation rod  Percutaneous endoscopic lumbar discectomy  Puncture and locate  Lumbar disc herniation

中文摘要:

  【摘要】 目的：探讨导航导杆引导椎间孔镜手术穿刺定位的作用，分析其可行性及临床应用价值。方法：选取2015年10月~2016年6月收治的腰椎间盘突出症患者60例，按入院顺序随机数字表法，分为导航组30例和传统组30例。两组均进行椎间孔镜手术，其中导航组采用导航导杆引导穿刺建立椎间孔镜工作套管，传统组采用传统C型臂X线机透视下建立椎间孔镜工作套管。比较两组术中穿刺次数、透视次数及穿刺时间及术后1d、3个月、6个月VAS评分。结果：两组患者术后腰腿痛症状即刻缓解，患肢直腿抬高试验转阴性。穿刺次数，导航组穿刺为1.10±0.31次，传统组为10.53±5.55次，差异具有统计学意义（P<0.05）。透视次数，导航组为8.30±1.24次，传统组为60.00±15.15次，差异具有统计学意义（P<0.05）。穿刺时间，导航组为5.05±2.01min，传统组为34.80±6.32min，差异具有统计学意义（P<0.05）。术后1d、3个月、6个月时VAS评分，导航组分别为2.6±0.8、1.8±0.4、1.4±0.3，传统组分别为2.8±1.1、2.1±0.2、1.6±0.5，两组病例VAS评分较术前降低（P＜0.05），两组病例同时间点VAS评分比较，差异无统计学意义（P＞0.05）。结论：利用导航导杆引可以精准引导椎间孔镜手术工作套管的建立，解决椎间孔镜技术的瓶颈问题，提高穿刺成功率，减少反复穿剌次数，避免副损伤及缩短穿刺时间，减少术者及患者X线辐射量，值得临床推广应用。

英文摘要:

  【Abstract】 Objectives: To discuss the effect of navigation rod in percutaneous endoscopic lumbar discectomy(PELD), and to analyze its feasibility and value. Methods: 60 consecutive patients with lumber disc herniation were divided into navigation group and tradition group, each group had 30 cases. Two groups received percutaneous endoscopic lumbar discectomy. Those who received self-made navigation rod to puncture were considered as navigation group, and those who received the traditional C-arm fluoroscopy for puncturing were considered as tradition group. The puncture times, fluoroscopic exposure times, puncture time and VAS after operation between 2 groups were compared. Results: All patients reached good pain relief, and Lasergue sign turn to negative. Compared with the two groups, the average of puncture times were 1.10±0.31 and 10.53±5.55 respectively in navigation group and tradition group(P<0.001). The fluoroscopic exposure times were 8.30±1.24 and 60±15.15 in navigation group and tradition group(P<0.001). The puncture time was 5.05±2.01min and 34.80±6.32min respectively in navigation group and tradition group(P<0.001). The postoperative(1 day, 3 months, 6 months) VAS score of navigation group was 2.6±0.8, 1.8±0.4, 1.4±0.3 respectively, while the VAS score of tradition group was 2.8±1.1, 2.1±0.2, 1.6±0.5 respectively, postoperative VAS scores of the two groups were lower than preoperative ones(P<0.05). There was no statistically difference between two groups with respect to the postoperative ones(P>0.05). Conclusions: It can solve the bottleneck problem of PELD, and improve the success rate of puncture, reduce puncture times, avoid injury and reduce puncture time, greatly reduce the X-ray exposure to surgeon and patient by using the navigation rod, which is worthy of clinical application.