新型定位板在经椎间孔腰骶神经根封闭术术前定位中的应用

发布时间：2018-06-05 00:27

本文选题：腰椎退行性疾病 + 定位板　；参考：《中国脊柱脊髓杂志》2017年04期

【摘要】：目的 :探讨新型定位板应用在腰椎后外侧经椎间孔腰骶神经根封闭术的术前定位中的有效性、可靠性。方法:2015年3月~2016年3月收治腰椎退行性疾病患者102例,其中单节段腰椎间盘突出症51例,单节段腰椎管狭窄症42例,经皮内窥镜下腰椎间盘切除术后症状复发9例,采用随机数字表随机分入两组后行腰椎后外侧经椎间孔腰骶神经根封闭术。A组54例,手术节段为L3/4 8例、L4/5 28例、L5/S1 18例,采用新型定位板术前定位;B组48例,手术节段为L3/4 8例、L4/5 26例、L5/S1 14例,采用金属定位针术前定位。两组患者年龄、性别、手术节段、保守治疗时间均无统计学差异(P0.05)。记录两组术前的透视次数和准备时间、穿刺时间、穿刺期透视次数、手术并发症、穿刺术后1h穿刺区疼痛VAS评分,并进行统计学分析。结果:A组术前的准备时间为5.2±1.0min、透视次数为1.1±0.3次,穿刺时间9.6±2.2min,穿刺期透视次数3.1±1.0次;B组术前的准备时间为10.7±2.3min、透视次数为3.8±1.2次,穿刺时间16.3±3.3min,穿刺期透视次数4.6±0.6次,两组比较均有统计学差异(P0.05),A组均优于B组。两组均未出现椎管内血肿、腹腔脏器损伤、下肢感觉和运动功能异常,B组出现硬膜刺裂1例(1/48)、穿刺区域皮下血肿4例(4/48),两组并发症发生率无统计学差异(P0.05);术后1h穿刺区域疼痛VAS评分,A组为3.4±0.5分,B组为5.0±0.9分,有统计学差异(P0.05)。结论:对于经椎间孔腰骶神经根封闭术,使用新型定位板术前定位,并进行穿刺路径设计,可减少术前透视次数、术前准备时间,有助于缩短穿刺时间及穿刺期透视次数,定位板具有使用方便、可靠、有效等优点。
[Abstract]:Objective: to investigate the validity and reliability of new positioning plate in the preoperative localization of lumbar posterolateral tranforaminal lumbosacral nerve root closure. Methods: 102 cases of lumbar degenerative diseases were treated from March 2015 to March 2016, including 51 cases of single segment lumbar disc herniation, 42 cases of single segment lumbar spinal stenosis, and 9 cases of recurrence of symptoms after percutaneous lumbar discectomy. Randomly divided into two groups, 54 cases were treated with lumbar posterolateral tranforaminal lumbosacral nerve root closure. The operative segment was L 3 / 48 cases, L 4 / R 5 cases, L 5 / S 1 18 cases, and group B 48 cases, which were treated with new positioning plate before operation. There were 14 cases of L5 / S1 with L3 / 48 cases with L4 / 526 cases with L5 / S1. There was no significant difference in age, sex, operative segment and conservative treatment time between the two groups (P 0.05). The preoperative fluoroscopy times, preparation time, fluoroscopy times, operative complications and VAS score of pain in puncture area 1 hour after puncture in both groups were recorded and statistically analyzed. Results the preoperative preparation time was 5.2 卤1.0 min, the fluoroscopy time was 1.1 卤0.3, the puncture time was 9.6 卤2.2 min, the puncture time was 3.1 卤1.0 times, the preoperative preparation time was 10.7 卤2.3 min, the fluoroscopy time was 3.8 卤1.2, the puncture time was 16.3 卤3.3 min, and the puncture period was 4.6 卤0.6 times. There was statistical difference between the two groups. Group A was better than group B. No intraspinal hematoma and abdominal viscera injury were found in both groups. There was no significant difference in the incidence of complications between the two groups (P < 0.05), and the VAS score of puncture area pain in group A was 3.4 卤0.5 min (P < 0.05), and that in group B was 5.0 卤0.9 (P < 0.05), and that of subcutaneous hematoma in puncture area (n = 4) was not significantly different from that in group B (P < 0.05) at 1 hour after operation, and there was no significant difference in the incidence of complications between the two groups (P < 0.05). There was statistical difference (P 0.05). Conclusion: for lumbar and sacral nerve root sealing through intervertebral foramen, the new type of positioning plate can be used to locate the nerve root before operation and design the puncture path, which can reduce the times of fluoroscopy before operation and the time of preparation before operation, and help to shorten the time of puncture and the times of fluoroscopy during puncture. The positioning plate has the advantages of convenience, reliability and efficiency.
【作者单位】：解放军总医院骨二科;
【分类号】：R687.3

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