个性化导板辅助经椎间孔内镜椎间盘切除术

Personalized guide aided percutaneous transforaminal endoscopic discectomy for lumbar disc herniation

摘要:

[目的] 探讨计算机辅助设计（computer aided design, CAD） /快速成型制造技术（rapid prototyping, RP） 个性导板在内镜治疗腰椎间盘突出症（Lumbar disc herniation, LDH） 的意义。[方法] 2021 年10 月—2022 年9 月本院脊柱外科收治的LDH 患者80 例随机分为两组，40 例采用导板引导下内镜椎间盘切除术，另外40 例采用常规内镜椎间盘切除术。比较两组临床及影像资料。[结果] 导板组手术时间[(53.3±8.8) min vs (74.8±13.4) min, P＜0.05]、术中透视次数[(2.9±0.7) 次vs (8.3±2.6) 次, P＜0.05] 、穿刺次数[(1.9±0.7) 次vs (4.5±1.3), P＜0.05]、术后下地时间[(1.4±0.2) d vs (2.6±0.5) d, P＜0.05] 均显著优于常规组。术后随时间推移，两组VAS 和RMDQ 评分均显著减少（P＜0.05），术前两组VAS、RMDQ 评分的差异均无统计学意义（P＞0.05），术后1周导板组的VAS [(1.0±0.3) vs (1.9±0.5), P＜0.05] 、RMDQ 评分[(2.2±0.8) vs (4.0±1.5), P＜0.05] 均显著低于常规组，术后1 个月，两组间上述评分的差异已无统计学意义（P＞0.05）。影像方面，与术前相比，术后两组椎管占位率均显著下降（P＜0.05），但相应时间点，两组间椎管占位率的差异均无统计学意义（P＞0.05）。[结论] 微创椎间孔镜治疗采用CAD/RP 个性导板，可提高穿刺成功率，在术后短期缓解疼痛及改善腰部功能方面更具优势。

Abstract:

[Objective] To explore the significance of computer aided design (CAD)/rapid prototyping (RP) personalized guide in percu-taneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH). [Methods] From October 2021 to September 2022,a total of 80 patients who were undergoing PTED in our hospital were randomly divided into two groups. Of them, 40 patients received person-alized guide aided PTED, while other 40 patients received conventional PTED. The clinical and imaging data of the two groups were com-pared. [Results] The guide group proved significantly superior to the conventional group in terms of operation time [(53.3±8.8) min vs (74.8±13.4) min, P＜0.05], intraoperative fluoroscopy times [(2.9±0.7) times vs (8.3±2.6) times, P＜0.05], puncture times [(1.9±0.7) times vs (4.5±1.3) times, P＜0.05], postoperative ambulation time [(1.4±0.2) days vs (2.6±0.5) days, P＜0.05]. The VAS and RMDQ scores significantly re-duced in both groups over time (P＜0.05). Although there were not statistically significant difference in above 2 scores between the two groupsbefore surgery (P＞0.05), the guide group was marked significantly lower than the conventional group 1 week postoperatively in terms of VASscore [(1.0±0.3) vs (1.9±0.5), P＜0.05] and RMDQ [(2.2±0.8) vs (4.0±1.5), P＜0.05], despite of the fact that the difference became not statisti-cally significant between the two groups 1 month after surgery (P＞0.05). Regarding imaging, the canal occupancy rate significantly decreasedin both groups postoperatively compared with that preoperatively in both groups (P＜0.05), whereas which was not significantly different be-tween the two groups at any time points accordingly. [Conclusion] The CAD/RP made personalized guide does improve the success rate ofpuncture, and has considerable advantages in short-term postoperative pain relief and lumbar function improvement.