[1]巩陈** 吴建明 张文志① 刘向阳 石志伟 段端强.三维可视化虚拟手术系统在经皮内镜下经椎间孔椎间盘切除术中的应用研究[J].中国微创外科杂志,2023,01(9):668-675.
　Gong Chen*,Wu Jianming*,Zhang Wenzhi,et al.Application of Threedimensional Visualization Virtual Surgery System in Percutaneous Transforaminal Endoscopic Discectomy[J].Chinese Journal of Minimally Invasive Surgery,2023,01(9):668-675.
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三维可视化虚拟手术系统在经皮内镜下经椎间孔椎间盘切除术中的应用研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年9期
页码:
668-675
栏目:
临床研究
出版日期:
2023-09-25

文章信息/Info

Title:
Application of Threedimensional Visualization Virtual Surgery System in Percutaneous Transforaminal Endoscopic Discectomy
作者:
巩陈** 吴建明 张文志① 刘向阳 石志伟 段端强
(安徽医科大学附属亳州医院脊柱外科，亳州236800)
Author(s):
Gong Chen*;  Wu Jianming*;  Zhang Wenzhi;  et al.
*Department of Spine Surgery, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou 236800, China
关键词:
经皮内镜手术; 椎间孔成形; 经椎间孔减压; 腰椎间盘突出症; 透视
Keywords:
Percutaneous endoscopic surgery; Foraminoplasty; Transforaminal decompression; Lumbar disc herniation; Fluoroscopy
文献标志码:
A
摘要:
目的探讨采用三维可视化虚拟手术系统(threedimensional visualization virtual surgery system,3DVVSS)联合自制椎间孔定位穿刺器(intervertebral foramen positioning puncture device,IFPPD)在经皮内镜下经椎间孔椎间盘切除术(percutaneous transforaminal endoscopic discectomy，PTED)治疗腰椎间盘突出症(lumbar disc herniation，LDH)中的应用效果。方法2021年1月~2022年2月我科70例LDH接受PETD，采用随机数字表法选择通道建立方法，35例采用3DVVSS联合IFPPD建立通道(可视化组)，35例采用传统徒手方法建立通道(传统组)，通道建立后采用经椎间孔内镜脊柱系统（transforaminal endoscopic spine system,TESSYS)完成椎间盘切除和神经根减压。比较2组穿刺次数、穿刺时间、透视次数、手术时间、住院时间、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数（Oswestry Disability Index,ODI)和并发症发生情况。结果70例顺利完成手术，无并发症发生。可视化组穿刺时间明显短于传统组［(14.7±4.0)min vs.(19.1±3.7)min，t=-4.765，P=0.000］,穿刺次数明显少于传统组［(3.8±1.9)次 vs.(7.3±2.4)次，t=-6.898，P=0000］，透视次数明显少于传统组［(8.3±31)次 vs.(14.5±4.0)次，t=-7.370，P=0.000］,手术时间明显短于传统组［(78.3±9.2)min vs.(88.4±14.3)min，t=-3.528，P=0.001］。2组术后VAS评分和ODI均优于术前，差异有统计学意义(均P=0.000)。结论PTED治疗LDH采用3DVVSS联合IFPPD可以明显减少穿刺次数、透视次数,缩短穿刺时间和手术时间，穿刺准确性高，手术效果满意，方法可行。
Abstract:
ObjectiveTo investigate the application effect of the threedimensional visualization virtual surgery system (3DVVSS) combined with the selfmade intervertebral foramen positioning puncture device (IFPPD) for percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH).MethodsFrom January 2021 to February 2022, 70 patients with LDH in our department underwent PTED. The random number table method was used to select the channel establishment method. A total of 35 cases were treated with 3DVVSS combined with the selfmade IFPPD to establish channel (visualization group), and another 35 cases were treated with traditional manual method (traditional group). After the channels were established, the TESSYS technology was used to complete the discectomy and nerve root decompression. The puncture times, puncture time, fluoroscopy times, operation time, hospitalization time, visual analogue scale (VAS), Oswestry disability index (ODI), and complications were compared between the two groups.ResultsThe operations were successfully completed in all the 70 patients, without serious complications. The visualization group was significantly shorter than the traditional group in terms of puncture time ［(14.7±4.0) min vs. (19.1±3.7) min, t=-4.765, P=0.000］. The number of punctures in the visualization group was significantly lower than that in the traditional group ［(3.8±1.9) times vs. (7.3±2.4) times, t=-6.898, P=0.000］. The fluoroscopy times in the visualization group was significantly lower than that in the traditional group ［(8.3±3.1) times vs. (14.5±4.0) times, t=-7.370, P=0.000］. The surgical time in the visualization group was significantly shorter than that in the traditional group ［(78.3±9.2) min vs. (88.4±14.3) min, t=-3.528, P=0.001］. The VAS and ODI in each group were better than preoperation, with differences statistically significant (all P=0.000).ConclusionsThe application of 3DVVSS combined with the selfmade IFPPD in PETD can significantly reduce the puncture times, fluoroscopy times, puncture time, and operation time in the treatment of patients with LDH. This method has high puncture accuracy, good safety, and satisfactory surgical results, which is feasible.

参考文献/References:

[1]Cheng YP, Cheng XK, Wu H. A comparative study of percutaneous endoscopic interlaminar discectomy and transforaminal discectomy for L5-S1 calcified lumbar disc herniation. BMC Musculoskelet Disord,2022,23(1):244-250.
[2]Zhou Z, Ni HJ, Zhao W, et al. Percutaneous endoscopic lumbar discectomy via transforaminal approach combined with interlaminar approach for L4/5 and L5/S1 twolevel disc herniation. Orthop Surg,2021,13(3):979-988.
[3]Wu B, Tian X, Shi C, et al. Clinical outcomes of “U” route transforaminal percutaneous endoscopic lumbar discectomy in chronic pain patients with lumbar spinal stenosis combined with disc herniation. Pain Res Manag,2021,2021:6657463.
[4]Goker B, Aydin S. Endoscopic surgery for recurrent disc herniation after microscopic or endoscopic lumbar discectomy. Turk Neurosurg,2020,30(1):112-118.
[5]Ma C, Li H, Wei Y, et al. Percutaneous endoscopic lumbar discectomy for huge lumbar disc herniation with complete dural sac stenosis via an interlaminar approach: an observational retrospective cohort study. Int J Gen Med,2021,14:8317-8324.
[6]Kim JY, Choi SY, Kim HS, et al. How I do it? Full endoscopic transforaminal approach for lumbar disc herniation that migrated bilaterally to four corners. Acta Neurochir (Wien),2021,163(4):1199-1203.
[7]宋启春,李全义,郭晓昀,等.“无视髂嵴”经皮椎间孔脊柱内镜系统技术治疗L5～S1腰椎间盘突出症.中国微创外科杂志,2020,20(5):599-603.
[8]Li WS, Yan Q, Cong L. Comparison of endoscopic discectomy versus nonendoscopic discectomy for symptomatic lumbar disc herniation:a systematic review and metaanalysis. Global Spine J,2022,12(5):1012-1026.
[9]Bai X, Lian Y, Wang J, et al. Percutaneous endoscopic lumbar discectomy compared with other surgeries for lumbar disc herniation: a metaanalysis. Medicine (Baltimore),2021,100(9):e24747.
[10]宋晓磊,王红建,黄鹏博,等.经皮内镜椎板间开窗与椎间孔入路治疗腰椎间盘突出症的比较.中国微创外科杂志,2021,21(5):405-409.
[11]Kotheeranurak V, Liawrungrueang W, Kuansongtham V, et al. Surgeons’ perspective, learning curve, motivation, and obstacles of fullendoscopic spine surgery in Thailand: results from a nationwide survey. Biomed Res Int,2022,2022:4971844.
[12]Yang J, Guo C, Kong Q, et al. Learning curve and clinical outcomes of percutaneous endoscopic transforaminal decompression for lumbar spinal stenosis. Int Orthop,2020,44(2):309-317.
[13]Ahn Y, Lee S, Son S, et al. Learning curve for transforaminal percutaneous endoscopic lumbar discectomy: a systematic review. World Neurosurg,2020,143:471-479.
[14]Wang R, Liang ZY, Chen XY, et al. Technical tips for percutaneous transforaminal endoscopic discectomy: a threestep maneuver for puncture and early clinical experience. Orthop Surg,2022,14(1):104-110.
[15]Liu X, Sun J, Zheng M, et al. Application of mixed reality using optical seethrough headmounted displays in transforaminal percutaneous endoscopic lumbar discectomy. Biomed Res Int,2021,2021:9717184.
[16]Wang H, Yuan H, Yu H, et al. Percutaneous endoscopic lumbar discectomy using a doublecannula guide tube for large lumbar disc herniation. Orthop Surg,2022,14(7):1385-1394.
[17]Zhou Z, Hu S, Zhao YZ, et al. Feasibility of virtual reality combined with isocentric navigation in transforaminal percutaneous endoscopic discectomy: a cadaver study. Orthop Surg,2019,11(3):493-499.
[18]Yu Z, Lu Y, Li Y, et al. A onestep foraminoplasty via a large trephine in percutaneous endoscopic transforaminal discectomy for the treatment of lumbar disc herniation. PLoS One,2022,17(5):e0268564.
[19]田霖,胡鹏,宁华秀,等.数字3D技术辅助经皮椎间孔镜椎间盘切除术治疗退行性腰椎管狭窄.中国微创外科杂志,2022,22(7):545-552.
[20]Ao S, Wu J, Tang Y, et al. Percutaneous endoscopic lumbar discectomy assisted by Oarmbased navigation improves the learning curve. Biomed Res Int,2019,2019:6509409.

备注/Memo

备注/Memo:
基金项目：安徽省重点研究与开发计划项目（202104j07020053）;安徽医科大学附属亳州医院三新项目（2021ZDA-01）**通讯作者，Email：gongchen19811119@163.com ①（中国科学技术大学附属第一医院脊柱外科，合肥230036)
更新日期/Last Update: 2023-12-01