椎间孔镜手术中漂移法与骨钻椎间孔成形法放置工作套管的比较

COMPARISON OF WORKING CANNULAS PLACEMENT BETWEEN DRIFT METHOD AND BONE DRILL ARTHROPLASTY IN TRANSFORAMINAL ENDOSCOPIC SURGERY

摘要:

目的：探讨在经皮椎间孔镜腰椎间盘切除术（percutaneous transforaminal endoscopic discectomy, PTED）中采用飘移法放置工作套管的优势和价值。方法：回顾性分析2019年6月~2020年12月本科室62例单节段腰椎间盘突出症患者行PTED手术的资料，其中32例采用骨钻椎间孔成形置管（A组），30例采用飘移法置管（B组）。比较2组术中透视次数及工作通道建立时间，采用视觉模拟评分法 ( visual analogue scale, VAS) 评价工作通道建立过程中病人的疼痛水平。术后1月、3月和6月应用VAS评分及Oswestry功能障碍指数 ( Oswestry disability index, ODI) 评估疗效，术后6月以改良MacNab标准评价手术优良率。结果：2组均顺利完成手术，无严重并发症的发生。B组透视14.3 ± 5.1次，工作通道建立用时22.2 ± 5.7min，较A透视次数（25.9 ± 7.8次）和工作通道建立用时（39.8 ± 9.3min）均显著减少（P < 0.01）。且B组放置工作通道过程中VAS评分显著低于A组。2组术后各时间点VAS评分和ODI较术前均显著下降，但2组之间术前、术后VAS评分、ODI及优良率比较均无统计学差异（P>0.05）。结论：与骨钻椎间孔成形置管比较，飘移置管同样满足手术要求，且显著缩短置管时间，降低辐射风险，减轻患者术中疼痛，值得在椎间孔镜手术中推广应用。

Abstract:

Objective: To investigate the advantages and value of dilator drift cannula in percutaneous transforaminal endoscopic discectomy ( PTED). Methods: A retrospective study was conducted on 62 patients with single segment lumber disc herniation who underwent PETD in our department from June 2019 to December 2020. Among them, 32 cases were used bone drill for intervertebral foraminoplasty to place the working cannula (group A), while the remaining 30 cases were used the dilator drift method to place the the working cannula (group B).The fluoroscopic exposure times and working cannula establishment time were compared between the two groups，and Visual Analogue Scale (VAS) was used to evaluate the pain level of patients during the establishment of working cannulas. VAS score and Oswestry disability index (ODI) were used to assess clinical outcomes at 1 month, 3 months and 6 months after operation, the excellent and good rates of the patients was evaluated by the modified MacNab criteria at 6 months after operation. Results: All the patients in both groups were completed operation successfully without serious complications. Compared with the two groups, the fluoroscopic exposure times were 25.9 ± 7.8 and 14.3 ± 5.1 respectively in group A and group B (P<0.01), the working cannula establishment time were 39.8 ± 9.3 min and 22.2 ± 5.7 min respectively in group A and group B (P<0.01). Especially, the VAS score in the process of establishing working cannula in group B was significantly lower than that in group A (P<0.01). As compared with preoperation，the VAS scores and ODI were significantly decreased at each time point after surgery in both groups (P<0.01), but there was no significant difference in VAS score, ODI and excellent and good rate between the two groups before and after operation (P>0.05). Conclusion: Compared with the bone drilling intervertebral foraminoplasty cannula, the dilator drifting cannula can also meet the operation requirements, and significantly shorten working cannula establishment time, decrease the radiation risk, reduce the pain of patients during operation, which is worthy of promotion in transforaminal endoscopic surgery.