超声CT融合影像椎间孔镜椎间盘切除术

Ultrasound-CT fusion imaging for percutaneous transforaminal endoscopic discectomy

摘要:

[目的] 探讨超声CT 融合影像椎间孔镜椎间盘切除术应用效果。[方法] 研究对象为医院在2021 年1 月—2023 年1月拟手术治疗的椎间盘突出症54 例患者，随机将患者分成两组，每组均为27 例。透视组予C 形臂X 线机引导椎间孔镜治疗；影像融合组予CT-超声融合成像引导下椎间孔镜治疗。比较围手术期、随访、影像学指标。[结果] 影像融合组手术时间[(89.2±10.7) min vs (109.3±11.8) min, P＜0.001]、穿刺时间[(9.2±1.1) min vs (13.8±2.5) min, P＜0.001]、术中透视次数[(3.8±0.8) 次vs(6.2±0.9) 次, P＜0.001] 及一次穿刺成功率[例(%), 22 (81.5) vs 15 (55.6), P=0.040] 均显著优于透视组。所有患者均随访12 个月，随时间推移，两组腰痛与腿痛VAS 评分、ODI 评分、JOA 评分均显著改善（P＜0.05），术后1 个月及末次随访时，融合组腰痛VAS评分[(3.6±0.9) vs (4.5±1.1), P＜0.001; (0.9±0.2) vs (1.3±0.3), P＜0.001] 与腿痛VAS 评分[(3.2±0.8) vs (3.7±0.9), P＜0.001; (1.1±0.2) vs(1.6±0.5), P＜0.001] 、ODI 评分[(45.5±5.6) vs (51.8±6.7), P＜0.001; (20.4±2.6) vs (25.4±3.4), P＜0.001]、JOA 评分[(16.2±2.3) vs (14.1±2.5), P＜0.001; (23.5±3.2) vs (19.7±3.5), P＜0.001] 均显著优于透视组。影像方面，与术前相比，末次随访两组患者椎管占位面积率显著降低（P＜0.05），椎间隙高度与腰椎前凸角无显著变化（P＞0.05），相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 超声CT 融合影像椎间孔镜椎间盘切除术可明显改善患者疼痛及腰椎功能，提高手术安全性。

Abstract:

[Objective] To investigate the efficacy of ultrasound-CT fusion imaging for percutaneous transforaminal endoscopic discec-tomy (PTED). [Methods] A total of 54 patients who were undergoing PTED for disc herniation were enrolled into this study in our hospitalfrom January 2021 to January 2023, and randomly divided into two groups, with 27 patients in each group. The fluoroscopy group had PTEDperformed under C-arm X-ray machine guide, while the image fusion group had PTED conducted with guide of ultrasound-CT fusion image.Perioperative, follow-up and imaging data were compared between the two groups. [Results] The image fusion group proved significantly su-perior to the fluoroscopy in terms of the operation time [(89.2±10.7) min vs (109.3±11.8) min, P＜0.001], puncture time [(9.2±1.1) min vs(13.8±2.5) min, P＜0.001], intraoperative fluoroscopy times [(3.8±0.8) times vs (6.2±0.9) times, P＜0.001], and success rate of first puncture[cases (%), 22 (81.5) vs 15 (55.6), P=0.040]. All patients in both groups were followed up for 12 months, and the low back pain and leg painVAS scores, as well as ODI and JOA scores in both groups were significantly improved over time (P＜0.05). The image fusion group was signif-icantly better than the fluoroscopy group regarding low back pain VAS score [(3.6±0.9) vs (4.5±1.1), P＜0.001; (0.9±0.2) vs (1.3±0.3), P＜0.001], leg pain VAS score [(3.2±0.8) vs (3.7±0.9), P＜0.001; (1.1±0.2) vs (1.6±0.5), P＜0.001], ODI score [(45.5±5.6) vs (51.8± 6.7), P＜0.001;(20.4±2.6) vs (25.4±3.4), P＜0.001], JOA score [(16.2±2.3) vs (14.1±2.5), P＜0.001; (23.5±3.2) vs (19.7±3.5), P＜0.001] 1 month after surgeryand at the latest follow-up. As for imaging, the ratio of vertebral canal occupied area was significantly decreased at the last follow-up com-pared with that preoperatively (P＜0.05), while the vertebral space height and lumbar lordosis angle remained unchanged significantly in bothgroups (P＞0.05). At corresponding time points, there were no statistically significant differences in the above imaging indicators (P＞0.05).[Conclusion] Ultrasonic CT fusion imaging PTED does significantly improve the pain symptom and lumbar function, and enhance the safetyof surgery.