腰椎间盘脱出椎间孔镜穿刺的三维影像测量△

Preoperative image measuring for improving puncture accuracy in transforaminal endoscopic discectomy for prolapsed lumbar disc herniation

摘要:

［目的］为椎间孔镜（transforaminal endoscopic spine system, TESSYSTM技术）手术的实施提供参考影像测量数据。［方法］ 回顾性分析 2014 年 7 月—2021 年 9 月 78 例接受椎间孔镜手术治疗的脱垂型腰椎间盘突出症患者的临床资料。术前影像测量穿刺的椎间孔宽度、安全水平距离、水平角度和头倾角度，并在术中验证是否达到预期穿刺目标靶点并评估手术有效率和安全性。［结果］不同脱垂程度同节段椎间孔宽度差异均无统计学意义（P>0.05），相同脱垂程度，不同节段间椎间孔宽度差异均有统计学意义（P<0.05）：椎间孔宽度：L_3/4>L_4/5>L₅S₁。安全水平角、穿刺进针点距离棘突的体表水平距离在不同脱垂程度同节段及相同脱垂程度不同节段间的差异均无统计学意义（P>0.05）。采用上述影像数据为引导，所有患者术中均达到靶向穿刺并顺利完成手术。［结论］术前影像三维测量有利于制定个性化穿刺规划，指导术中安全准确地穿刺。

关键词:脊柱内镜;TESSYSTM技术;三维定向;脱垂型腰椎间盘突出症;靶向穿刺

Abstract:

[Objective] To provide imaging data for accurate puncture in percutaneous transforaminal endoscopic discectomy (PTED, TESSYSTM technique) for prolapsed lumbar disc herniation (LDH) . [Methods] A total of 78 patients who were undergoing PTED for pro- lapsed LDH were enrolled in this study from July 2014 to September 2021. Preoperative images were used to measure the width of interverte- bral foramen, safe horizontal distance, horizontal angle and head tilt angle during puncture. In addition, the imaging data were used to guide the puncture in real operation, and verified by the precise, efficiency and safety of the operation based on whether the expected puncture tar- get was reached. [Results] There was no significant difference in the width of intervertebral foramen among different prolapse extents (P＞ 0.05) , whereas which were of statistically significant difference among different levels in the same prolapse extent (P＜0.05) . The foraminal width was significantly ranked up- down as L_3/4＞L_4/5＞L₅S₁. However, there were no significant differences in the safe horizontal angle, the body surface distance between puncture point and spinous process in the same segment with different prolapse extents and in different seg- ments with the same prolapse extents (P＞0.05) . Applying the abovementioned imaging data as guide, all the patients achieved accurate tar- geted puncture point and had operation completed successfully. [Conclusion] The preoperative image measurement data are beneficial to develop personalized puncture planning and guide safe and accurate puncture during surgery.

Key words:spinal endoscopy; TESSYSTM technique; three-dimension alorientation; prolapsed lumbar disc herniation; targeted puncture