3D打印导板辅助脉冲射频联合硬膜外置管镇痛术治疗腰椎术后疼痛综合征的临床研究

3D printed navigation template-guided percutaneous pulsed radiofrequency combined with epidural catheter analgesia for failed back surgery syndrome treatment

摘要:

目的：评估3D打印导航模板在脉冲射频联合硬膜外置管镇痛治疗腰椎术后疼痛综合征中的有效性及安全性。方法：选取2022年5月至2023年5月在山西白求恩医院接受脉冲射频联合硬膜外置管镇痛术治疗腰椎术后疼痛综合征的患者40例，其中在常规体表定位CT引导下行脉冲射频联合硬膜外置管镇痛术的患者为A组（n=20），采用3D打印导板辅助脉冲射频联合硬膜外置管镇痛术的患者为B组（n=20）。记录两组患者术中情况：手术时长、到达靶点的穿刺次数、术中CT扫描次数、术中辐射剂量、术中呻吟/体动发生情况及术后并发症，同时记录术前（T0）、术后2周（T1）、1月（T2）、3月（T3）疼痛视觉模拟评分法（visual analogue scale, VAS）评分和日本骨科协会腰痛评分量表（Japanese orthopaedic association, JOA）评分。结果：与A组相比，B组手术时长、到达靶点的穿刺次数、术中CT照射次数、术中辐射剂量、术中呻吟/体动发生率均明显小于A组（P＜0.01）；与术前相比，两组患者治疗后VAS评分均明显降低（P＜0.05），JOA评分均明显升高（P＜0.05）；两组患者术后各时间段评分组间差异无统计学意义。A组1例患者出现穿刺部位血肿，B组患者均未发生并发症。结论：3D打印导航模板能够明显提高腰椎术后疼痛综合征患者手术穿刺精准性、安全性，缩短手术时间，减少辐射剂量，提高手术治疗的效率与质量。

Abstract:

Objective： To evaluate the effectiveness and safety of 3D printed navigation templates in the treatment of failed back surgery syndrome using pulsed radiofrequency combined with epidural catheter analgesia. Methods： Forty patients with failed back surgery syndrome who received pulsed radiofrequency combined with epidural catheter analgesia in Shanxi Bethune Hospital from May 2022 to May 2023 were selected. Patients in Group A (n=20) were treated with pulsed radiofrequency combined with epidural catheter analgesia under CT guidance, patients in Group B (n=20) received 3D printed guide plate-assisted pulsed radiofrequency combined with epidural catheter analgesia. The intraoperative conditions of all patients were recorded, including the length of operation, the number of punctures, the number of intraoperative CT scans, the intraoperative Radiation exposure, the incidence of groans/body movements and postoperative complications. At the same time, the visual analog scale (VAS) and the Japanese Orthopaedic Association (JOA) of pain were recorded before (T0), 2 weeks (T1), 1 month (T2), and 3 months (T3). Results： Compared with group A, the operation duration, number of punctures, CT irradiation times, Radiation exposure and groans/body movements in group B were significantly shorter than those in group A (P<0.05).Compared with preoperative treatment, both groups of patients showed a significant decrease in VAS scores (P<0.05) and a significant increase in JOA scores (P<0.05) after treatment.There was no statistically significant difference in postoperative scores between the two groups of patients at different time periods.One patient in Group A experienced postoperative hematoma at the puncture site, while none of the patients in Group B experienced any complications.Conclusion： 3D printed navigation template can significantly improve the accuracy and safety of surgical puncture for patients with failed back surgery syndrome, shorten the operation time, reduce Radiation exposure, and improve the efficiency and quality of surgical treatment.