椎间孔镜通道导向模块在椎间孔镜治疗腰椎间盘突出症中的应用OACSTPCD
Clinical application of transforaminal endoscope-guided module in treatment of lumbar disc herniation by transforaminal endoscopic
目的 探讨椎间孔镜通道导向模块在椎间孔镜治疗腰椎间盘突出症中的应用价值.方法 选取 60 例L5/S1 腰椎间盘突出症患者,将其随机分为模块组和对照组各 30 例.模块组采用一种自创的椎间孔镜通道导向模块辅助穿刺,对照组采用传统徒手穿刺放置工作管道.比较 2 组的一次穿刺成功率、定位穿刺时间和术中X线透视次数,观察并发症发生情况,比较 2 组术后 3 个月的视觉模拟评分法(VAS)评分、臀部和下肢功能障碍指数(ODI)评分,并采用改良Mac Nab评分评估 2 组疗效.结果 2 组患者术程均顺利.与对照组比较,模块组一次穿刺成功率更高、穿刺时间更短、术中X线透视次数更少(P均<0.05).2组患者术中并发症发生率比较差异无统计学意义(P>0.05),术后均无出现严重并发症.2 组患者术后 3 个月的VAS评分与ODI评分均较术前降低(P均<0.01),模块组与对照组术后 3 个月的VAS、ODI评分比较差异均无统计学意义(P均>0.05),但 2 组VAS术前术后评分差值比较差异有统计学意义(P<0.05).模块组改良Mac Nab评分优良率为 83.3%(25/30),对照组优良率为 80.0%(24/30),2 组比较差异无统计学意义(P>0.05).结论 在椎间孔镜治疗腰椎间盘突出症中,椎间孔镜通道导向模块操作简便且安全,可以缩短穿刺时间、提高穿刺效率、减少医源性损伤,值得在临床进一步推广应用.
Objective To evaluate the clinical application value of transforaminal endoscope-guided module in the treatment of lumbar disc herniation by transforaminal endoscopic.Methods Sixty patients with L5/S1 lumbar disc herniation were randomly divided into the module group and control group,with 30 cases in each group.In the module group,self-designed transforaminal endoscope-guided module was utilized to assist puncture,and conventional manual puncture was adopted to place the working channel in control group.The success rate of one-time puncture,positioning puncture time and intraoperative X-ray fluoroscopy times were compared between two groups,and the incidence of complications was observed.The Visual Analogue Scale(VAS)score and Oswestry Disability Index(ODI)score of the hip and lower limbs at postoperative 3 months were compared between two groups.Postoperative modified Mac Nab score was employed to evaluate clinical efficacy between two groups.Results All patients successfully completed the operation.Compared with the control group,the success rate of one-time puncture was higher,positioning puncture time was shorter and the times of intraoperative X-ray fluoroscopy was less in the module group(all P<0.05).There was no statistical significance in the incidence of intraoperative complications between two groups(P>0.05),and no severe postoperative complications were noted in two groups.In two groups,the VAS score and ODI score at postoperative 3 months were less compared with preoperative levels(both P<0.05),and there was no statistical significance between two groups(both P>0.05),however,the difference of VAS between preoperative and postoperative values was statistically significant(P<0.05).There was no statistical significance in the excellent rate of modified Mac Nab score between the module(83.3%(25/30))and control groups(80.0%(24/30),P>0.05).Conclusions Transforaminal endoscope-guided module is safe and convenient.This module can effectively shorten puncture time,enhance puncture efficiency and minimize iatrogenic injuries,which is worthy of clinical application.
林夏晴;杨萍;温子阳;袁世民
广州中医药大学,广东 广州 510006湖北省中西医结合医院,湖北 武汉 430015广东省中西医结合医院 广东 佛山 528253
椎间孔镜通道导向模块经皮椎间孔镜椎间盘切除术辅助穿刺装置腰椎间盘突出症经椎间孔入路
Transforaminal endoscope-guided modulePercutaneous transforaminal endoscopic discectomyAuxiliary puncture deviceLumbar disc herniationTransforaminal route
《新医学》 2024 (008)
608-616 / 9
广东省基础与应用基础研究基金项目(2021A1515220157);广东省佛山市科技局科技创新项目(2220001004884)
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