一种新型三轴调节式精准穿刺定位器在椎间孔镜穿刺定位的临床应用-东南大学学报医学版

一种新型三轴调节式精准穿刺定位器在椎间孔镜穿刺定位的临床应用

单位：1. 南京鼓楼医院集团宿迁市人民医院骨科, 江苏宿迁 223800;
2. 东南大学附属中大医院骨科, 江苏南京 210009

分类号：R681.5

出版年·卷·期（页码）：2019·38·第一期（125-130）

摘要：

目的：设计一种新型三轴调节式精准脊柱穿刺定位器，阐述其设计原理及方法，探索其辅助经皮椎间孔镜穿刺定位的临床应用价值。方法：研制一种新型三轴调节式脊柱穿刺定位器，辅助椎间孔镜穿刺定位。选取2016年1月-2017年6月接受椎间孔镜手术治疗的64例腰椎间盘突出症患者，随机将患者均分为两组，即新型三轴调节式精准脊柱穿刺定位器辅助组（辅助组）与采用传统C型臂X线机透视下完成穿刺定位的传统组（传统组）。比较两组患者术中透视次数、穿刺次数、穿刺时间以及术前、术后1 d、术后3个月、术后6个月VAS评分和手术并发症差异。结果：平均透视次数辅助组为（7.4±1.7）次，传统组为（18.4±3.8）次，两组差异有统计学意义（P<0.05）。平均穿刺次数辅助组为（1.4±0.4）次，传统组为（8.3±4.3）次，两组差异有统计学意义（P<0.05）。平均穿刺时间辅助组为（6.36±3.08）min，传统组为（24.54±6.72）min，两组差异有统计学意义（P<0.05）。术前、术后1 d、术后3个月、术后6个月VAS评分，辅助组分别为（7.8±2.1）、（2.1±0.9）、（1.7±0.6）、（1.3±0.4）分，传统组分别为（7.9±1.9）、（2.3±1.0）、（1.8±0.4）、（1.5±0.3）分，两组患者术后VAS评分较术前均明显降低（P<0.05），术后两组患者同一时间点VAS评分差异无统计学意义（P>0.05）。传统组有1例患者术中穿刺过程中出现一过性下肢疼痛、麻木加剧，调整穿刺方向后症状缓解，术后无根性疼痛症状残留。有1例患者术后1月余复发，后行开放手术治疗。辅助组患者无相关并发症发生。两组患者并发症差异无统计学意义（P>0.05）。结论：新型三轴调节式精准脊柱穿刺定位器辅助穿刺定位，可以明显提高穿刺准确率，减少穿刺次数及时间，并发症发生率低，有效改善患者症状，临床疗效确切。

Objective:To discuss the design principle and operation method of a new triaxial puncture locator, and to explore its clinical application value in percutaneous endoscopic lumbar discectomy(PELD). Methods:A new three-axis adjustable spinal puncture locator was developed to assist intervertebral foramen puncture positioning. Sixty-four patients with lumbar intervertebral disc herniation who received PELD were randomly divided into two groups, namely the auxiliary group of the new triaxial adjustable spine puncture locator and the traditional group who received the traditional C-arm fluoroscopic for puncture at the time of postoperative 1 day, postoperative 3 months, postoperative 6 months. The intraoperative fluoroscopy times, puncture times, puncture time and VAS score and postoperative complications after operation between the two groups were compared at the time of postoperative 1 day, postoperative 3 months, postoperative 6 months. Results:The average of fluoroscopy times were (7.4±1.7) and (18.4±3.8)respectively in the auxiliary group and the traditional group(P<0.05). The puncture times were(1.4±0.4)and(8.3±4.3)respectively in the auxiliary group and traditional group(P<0.05). The puncture time was (6.36±3.08)min and (24.54±6.72)min respectively in the auxiliary group and the traditional group(P<0.05). The preoperative and postoperative(1 day, 3 months, 6months) VAS scores were (7.8±2.1),(2.1±0.9),(1.7±0.6),(1.3±0.4)respectively in the auxiliary group. While the VAS scores were (7.9±1.9),(2.3±1.0),(1.8±0.4) and (1.5±0.3) respectively in the traditional group. Postoperative VAS scores of the two groups were lower than those of preoperative ones (P<0.05). There was no statistical difference in terms of postoperative VAS scores between the two groups at the same time points(P>0.05).In the traditional group, one patient experienced transient lower limb pain and numbness aggravation during intraoperative puncture. After adjusting the direction of puncture, the symptoms were relieved. One patient experienced a recurrence after operation. No complications occurred in patients in the auxiliary group. The complications of the two groups were not statistically significant (P>0.05). Conclusion:The new triaxial puncture locator in percutaneous endoscopic lumbar discectomy can significantly improve the puncture accuracy, reduce the puncture times and time, reduce the incidence of complications, effectively improve the symptoms of patients and and the clinical effect is accurate.

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