基于术中C臂X光图像骨性标识的椎间孔镜手术路径构建

doi:10.6040/j.issn.1671-7554.0.2024.1205

摘要/Abstract

摘要： 目的通过分析腰椎薄层CT图像,归纳椎间孔镜侧路穿刺定位的规律;依据术中C臂X光骨性标识构建椎间孔镜手术路径,应用于临床验证其安全性及有效性。方法 (1)选取山东第一医科大学第一附属医院2022年1月至2024年5月收治的30例腰椎间盘突出症(lumbar disc herniation, LDH)患者腰椎薄层CT图像,通过影像解剖研究,探究椎间孔镜侧路穿刺规律,确立术中C臂X光图像上骨性标记交叉线定点穿刺方法,构建安全有效的椎间孔镜穿刺路径。(2)选取2023年5月至2024年5月我院收治的行孔镜手术LDH患者80例,按随机数字表法分为交叉点定位法组(n=40)和体表定位法组(n=40)。所有患者均行侧路椎间孔镜手术治疗,手术均由具备熟练操作脊柱内镜手术的高年资医师按照随机分配原则进行。分析两组临床疗效、术中各指标及术后并发症等。结果交叉点定位法组总有效率高于体表定位法组,两组差异有统计学意义(P<0.05);一次穿刺成功率交叉点定位法组97.5%,体表定位法组80%,两组差异有统计学意义(P<0.05);建立工作通道时间交叉点定位法组(16.32±3.97)min,体表定位法组(26.32±5.93)min,两组差异有统计学意义(P<0.05);平均透视次数交叉点定位法组(8.93±2.12)次,体表定位法组(17.53±2.73)次,两组差异有统计学意义(P<0.001);术中透视辐射剂量交叉点定位法组为(10.27±5.72)mGy,体表定位法组为(17.16±4.27)mGy,两组差异有统计学意义(P<0.01);交叉点定位法组术后疼痛视觉模拟评分、Oswestry功能障碍指数较体表定位法组下降明显(P<0.05);两组均未发生严重并发症。结论交叉点定位法相比既往穿刺定位方法优势显著,为椎间孔镜手术提供一种安全且有效、精准易标识、简便易掌握的穿刺定位方法。

关键词: 手术路径构建, 椎间孔镜手术, 影像解剖, 骨性标识, C臂X光

Abstract: Objective To summarise the rules of lateral puncture positioning for the intervertebral foramen endoscopy by analyzing thin-slice CT images of the lumbar spine and to construct a surgical path for intervertebral foramen endoscopy based on the intraoperative C-arm X-ray bone landmarks, so as to apply it to clinical verification of its safety and effcacy. Methods (1) Thirty patients with lumbar disc herniation(LDH)admitted to The First Affiliated Hospital of Shandong First Medical University from January 2022 to May 2024 were selected for lumbar thin-layer CT imageing. The rules of lateral puncture of intervertebral foramen endoscopy were explored through imaging anatomy research, and the method of fixed-point puncture of the cross line of bone landmarks on intraoperative C-arm X-ray imageing was established to construct a safe and effective puncture path of intervertebral foramen endoscopy. (2) Eighty patients with LDH who underwent intervertebral foramen endoscopy surgery in our hospital from May 2023 to May 2024 were selected and divided into the cross-point positioning method group(n=40)and the surface positioning method group(n=40)according to the random number table method. All patients underwent lateral foraminal endoscopic surgery, and the surgery was performed by senior physicians experienced in spinal endoscopic surgery according to the principle of random allocation. The clinical efficacy, intraoperative parameters and postoperative complications of the two groups were observed and analysed. Results The overall efficacy rate of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant(P<0.05). The single puncture success rate was 97.5% in the cross-point positioning method group and 80% in the surface positioning method group, and the difference between the two groups was statistically significant(P<0.05). The time to establish the working channel was(16.32±3.97)min in the cross-point positioning method group and(26.32±5.93)min in the surface positioning method group, and the difference between the two groups was statistically significant(P<0.05). The mean number of fluoroscopy times was 8.93±2.12 in the cross-point positioning method group and 17.53±2.73 in the surface positioning method group, with a statistically significant difference between the two groups(P<0.001). The intraoperative fluoroscopic radiation dose in the cross-point positioning method group was(10.27±5.72)mGy, while that in the cross-point positioning method group was(17.16±4.27)mGy, with a significant difference between the two groups(P<0.01). The postoperative VAS score and ODI scores in the cross-point positioning method group were significantly lower than those in the surface positioning method group(P<0.05). There was no serious complications occurred in either group. Conclusion The cross-point positioning method has significant advantages over the previous puncture positioning method, and provides a safe, effective, accurate, easy-to-mark, simple and easy-to-learn puncture positioning method for transforaminal endoscopic lumbar discectomy.

Key words: Surgical pathway construction, Transforaminal endoscopic lumbar discectomy, Imaging anatomy, Bony landmarks, C-arm X-ray

中图分类号:

R615

张翼翔,梁原浩,杨文龙,李国强,吴文庆,刘垒. 基于术中C臂X光图像骨性标识的椎间孔镜手术路径构建[J]. 山东大学学报 (医学版), 2025, 63(3): 14-21.

ZHANG Yixiang, LIANG Yuanhao, YANG Wenlong, LI Guoqiang, WU Wenqing, LIU Lei. Construction of a transforaminal endoscopic surgical path based on bone landmarks in intraoperative C-arm X-ray radiographs[J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 14-21.

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