摘要
目的 研究经皮内镜下可视化置钉在经皮内镜下后路腰椎融合术(Endo-PLIF)椎弓根螺钉置钉中的应用价值。方法 纳入2020年10月—2021年4月我院有腰椎融合手术指征的腰椎间盘源性腰痛、腰椎管狭窄症伴腰椎不稳、腰椎间盘突出症伴腰椎不稳、腰椎滑脱症(Meyerding分级I、II)患者共50例。50例患者随机分为甲、乙两组,每组25例。甲组的手术方式为经皮内镜下后路腰椎融合术+经皮脊柱内镜下可视化椎弓根螺钉置钉,乙组的手术方式为经皮内镜下后路腰椎融合术+传统X线透视下经皮椎弓根螺钉置钉。比较两组X线透视总次数、导丝置入时间、手术时间、术后住院时间;采用Gertzbein-Robbins标准评价置钉优良率;术前及术后24 h VAS评分和ODI指数、改良Macnab标准及术后并发症的发生率评价疗效。同时对经皮内镜下改进的置钉器械进行3D打印制造并验证其可行性、实用性。通过上述指标观察其医患X线辐射情况、微创性、置钉的优良率及手术效果。结果 全部患者均完成了手术和随访。甲组患者X线透视总次数、手术时间、导丝置入时间,均少于乙组(P<0.05),两组术后住院时间比较差异无统计学意义(P>0.05)。两组术前、术后24 h VAS、ODI比较差异无统计学意义(P>0.05),但两组术后24 hVAS、ODI均较术前改善(P<0.05)。末次随访时,两组患者改良Macnab标准的优良率比较差异无统计学意义(P>0.05)。甲组经皮内镜置钉优良率优于乙组(P<0.05)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论 经皮内镜下置钉能减少医患X线辐射次数,降低医患辐射暴露风险,且置钉的优良率较高;同时,3D打印的经皮内镜下置钉器械具有可行性和实用性。
Objective To explore application value of percutaneous endoscopic visualization of screw placement in percutaneous endoscopic posterior lumbar interbody fusion(Endo-PLIF)pedicle screw placement.Methods A total of 50 patients with lumbar discogenic low back pain,lumbar spinal stenosis with lumbar instability,lumbar disc herniation with lumbar instability,and Lumbar spondylolisthesis(Meyerding classification I and II)with indications for lumbar fusion surgery from October 2020 to April 2021 are selected.Fifty patients were randomly divided into the two groups,A and B,with 25 patients in each group.In group A,the procedure is Endo-PLIF+Visual pedicle screw placement under percutaneous spinal endoscopy,while in group B,the procedure is Endo-PLIF+traditional percutaneous pedicle screw placement.The total number of X-ray fluoroscopies,guide wire placement time,operation time,and postoperative hospital stay are compared between the two groups.The Gertzbein-Robbins criteria are used to evaluate the excellent rate of nail placement.The preoperative and 24-hour postoperative VAS score and ODI index,modified MacNab criteria and postoperative complication rate to evaluate the efficacy.Besides,improved percutaneous endoscopic nail placement device is manufactured by 3D printing and research validates its feasibility and practicality.The above mentioned indexes were used to observe X-ray radiation for doctors and patients,minimally invasive nature,excellent rate of nail placement and surgical results.Results All patients complete the operation and follow-up visits.The total frequencies of fluoroscopy in A group is less than B group's(P<0.05).The pedicle wire insertion time and operation time in group A are less than those in group B(P<0.05).No significant differences are found in postoperative hospital stay in A group compared with B group(P>0.05).There is no significant difference in VAS and ODI between the two groups compared with each other before and 24 hours after surgery(P>0.05).However,VAS and ODI in both groups at 24-hour postoperatively are markedly ameliorated compared with those before surgery(P<0.05).At the final follow-up,there is no significant difference in the excellent rate of modified MacNab between the two groups(P>0.05).Comparing the two groups,the excellent rate of percutaneous endoscopic nail placement in A group is better than B group(P<0.05).The difference in the incidence of postoperative complications is not statistically significant(P>0.05).Conclusion Percutaneous endoscopic screw placement can reduce the number of X-ray and radiation exposure risk for doctors and patients,and the excellent rate of nail placement is relatively high.Meanwhile,the 3D-printed percutaneous endoscopic screw placement instruments have feasibility and practicality.
作者
李枫
刘德敏
侯伟光
LI Feng;LIU Demin;HOU Weiguang(Department of Orthopedics,363 Hospital Affiliated to Southwest Medical University,Chengdu 610041,China)
出处
《西部医学》
2023年第8期1167-1172,共6页
Medical Journal of West China
基金
吴阶平医学基金会临床科研专项资助课题(320.6750.2021-6-7)。
关键词
内镜
微创
腰椎融合术
腰椎退行性疾病
效率
Endoscopy
Minimally Invasive
Lumbar Interbody Fusion
Lumbar Degenerative Disease
Efficiency
