[1]刘晓强罗嘉谊谷昌伟李铠湘钟章华赵湘军李锐冰王洪伟**.简易画线穿刺法联合可视化关节突成形技术在侧路椎间孔镜手术中的应用[J].中国微创外科杂志,2025,01(4):227-232.
 Liu Xiaoqiang,Luo Jiayi,Gu Changwei,et al.Application of Simple Drawing Line Puncture Combined With Visual Articular Process Arthroplasty Technique in Lateral Foraminoscopy[J].Chinese Journal of Minimally Invasive Surgery,2025,01(4):227-232.
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简易画线穿刺法联合可视化关节突成形技术在侧路椎间孔镜手术中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年4期
页码:
227-232
栏目:
临床研究
出版日期:
2025-04-25

文章信息/Info

Title:
Application of Simple Drawing Line Puncture Combined With Visual Articular Process Arthroplasty Technique in Lateral Foraminoscopy
作者:
刘晓强罗嘉谊谷昌伟李铠湘钟章华赵湘军李锐冰王洪伟**
(东莞东华医院脊柱外科,东莞523110)
Author(s):
Liu Xiaoqiang Luo Jiayi Gu Changwei et al.
Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan 523110, China
关键词:
腰椎间盘突出症侧路椎间孔镜手术简易画线穿刺可视化关节突成形术
Keywords:
Lumbar disc herniationLateral foraminal endoscopic surgerySimple drawing line punctureVisual articular process arthroplasty
文献标志码:
A
摘要:
目的探讨简易画线穿刺法联合可视化关节突成形技术在侧路椎间孔镜的应用价值。方法回顾性分析2019年5月~2022年12月采用侧路椎间孔镜手术治疗单节段腰椎间盘突出症89例,其中35例采用传统经皮椎间孔脊柱内镜系统(transforaminal endoscopic spine system,TESSYS)技术(常规组),54例采用简易画线穿刺法联合可视化关节突成形技术(改良组),比较2组透视次数、穿刺时间、手术时间、术后3 d及末次随访腰腿痛视觉模拟评分(Visual Analogue Score,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)和MacNab疗效。结果所有手术都顺利完成,无中转开放手术。常规组1例L4神经根损伤,考虑术中神经根挤压损伤,术后下肢肌力无异常,但神经支配皮节区痛觉过敏、麻木,伴夜间抽筋,予普瑞巴林、甲钴胺、维生素B1和B6治疗2个月后好转,随访至1年后恢复正常;其余病例无硬膜、腹部脏器损伤、切口感染等并发症发生。常规组复发1例,改良组复发2例,3例复发均发生在术后3个月内,其中2例症状较重,再次行内镜翻修手术,1例选择保守治疗后好转。与常规组相比,改良组穿刺次数[(1.8±0.7)次vs. (7.5±1.1)次,t=27.543,P=0.000]、[透视次数(5.7±1.8)次vs.(23.2±2.2)次,t=41235,P=0000]和手术时间[(72.7±7.2)min vs.(92.7±7.7)min,t=12.317,P=0.000]均明显减少或缩短;2组术后住院时间[(3.2±0.6)d vs.(3.3±0.6)d,t=0.062,P=0.951]差异无显著性。常规组随访(14.0±1.3)月,改良组随访(13.6±12)月,2组末次随访腰退痛VAS评分[(1.5±0.6)分vs.(1.6±0.7)分,t=0.751,P=0.455]、ODI[(10.8±3.4)% vs.(118±3.9)%,t=1.284,P=0.202]、MacNab标准优良率[100%(54/54) vs. 100%(35/35),Z=-0.981,P=0327]差异无显著性。结论简易画线穿刺法联合可视化关节突成形技术可以显著提高椎间孔穿刺的准确性,操作简单,减少医患X线暴露,缩短手术时间,手术安全性提高,值得在经皮椎间孔镜手术中推广应用。
Abstract:
ObjectiveTo explore the application value of simple drawing line puncture combined with visual articular process arthroplasty in lateral foraminoscopy.MethodsA retrospective analysis was performed on 89 patients with singlesegment lumbar disc herniation treated with lateral foraminoscopy from May 2019 to December 2022, including traditional transforaminal endoscopic spine system (TESSYS) technology (conventional group, 35 cases) and simple drawing line puncture combined with visual articular process arthroplasty (modified group, 54 cases). The fluoroscopy times, puncture time, and operation time of the two groups were compared. The Visual Analogue Score (VAS), Oswestry Disability Index (ODI), and MacNab criteria were used to evaluate the surgical effect at 3 d after surgery and at the last followup.ResultsAll the operations were successfully completed without conversion to open surgery. In the conventional group, there was 1 case of L4 nerve root injury, who was considered intraoperative nerve root compression injury. There was no abnormality in lower limb muscle strength after surgery, but hyperalgesia and numbness in the innervated cutaneous area accompanied by nocturnal cramps. The patient was given treatment with pregabalin, mecobalamin, vitamin B1 and B6 for 2 months, and returned to normal at 1 year of followup. The other cases had no complications such as dural injury, abdominal organ injury, or incision infection. Recurrence occurred in 1 case in the conventional group and 2 cases in the modified group, and all the 3 cases occurred within 3 months after operation. Among them, 2 patients had severe symptoms and underwent endoscopic revision again, and the other patient improved after conservative treatment. Compared with the conventional group, the puncture times [(1.8±0.7) times vs. (7.5±1.1) times, t=27543, P=0.000], fluoroscopy times [(5.7±1.8) times vs. (23.2±2.2) times, t=41235, P=0.000] and operation time [(72.7±7.2) min vs. (92.7±7.7) min, t=12.317, P=0.000] in the modified group were significantly reduced or shortened, and there was no significant difference in postoperative hospital stay [(3.2±0.6) d vs. (33±0.6) d, t=0.062, P=0.951] between the two groups. The conventional group was followed up for (14.0±1.3) months and the modified group was followed up for (13.6±1.2) months. There were no significant differences in VAS scores [(1.5±0.6) points vs. (1.6±0.7) points, t=0.751, P=0.455], ODI[(10.8±3.4)% vs. (11.8±3.9)%, t=1.284,P=0.202], and excellent and good rate of MacNab criteria [100% (54/54) vs. 100% (35/35), Z=-0.981, P=0.327] between the two groups at the last followup.ConclusionsSimple drawing line puncture combined with visual articular process arthroplasty can significantly improve the accuracy of intervertebral foramen aspiration, with simple operation, reduced Xray exposure for doctors and patients, shortened operation time, and improved surgical safety. It is worthy of promotion and application in percutaneous foraminoscopy.

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备注/Memo

备注/Memo:
基金项目:广东省医学科研基金(B2023334)**通讯作者,Email:liuxiaoqiang318@163.com
更新日期/Last Update: 2025-06-17