TESSYS技术治疗脱垂型腰椎间盘突出症穿刺头倾角的安全范围

发布时间：2018-11-26 07:33

【摘要】：[目的]应用影像后处理软件(Vue PACS)行腰椎DR、CT、MRI测量经椎间孔入路TESSYS技术靶向治疗椎管内脱垂型腰椎间盘突出症的穿刺头倾角度安全范围,为TESSYS技术提供安全精确的参考数据;通过术前测定的穿刺头倾角安全范围在临床实践中验证TESSYS技术治疗椎管内脱垂型腰椎间盘突出症的安全性。[方法]选取2013年7月~2016年12月在本院接受经椎间孔入路的腰椎间盘髓核摘除手术治疗的椎管内脱垂型腰椎间盘突出症患者共59例。术前在本院Vue PACS上测量以下指标:髓核脱垂程度(MRI)、穿刺针进针深度及判断责任椎间孔是否狭窄(CT)、L_(3~4)、L_(4~5)、L_5~S_1椎间盘轻、重度脱垂的头倾角度安全范围(DR)。根据测量的头倾角范围判定是否能够达到预期穿刺目标以及手术有效率和安全性。[结果]按照术前测定的穿刺头倾角范围,所有患者穿刺均达到预定位置,手术有效率和安全性分别为90.6%、100%。L_(3~4)、L_(4~5)、L_5~S_1椎间隙头倾角安全范围中央型轻度脱垂为15°~30°,重度脱垂为40°~45°;非中央型轻度脱垂为35°~45°,重度脱垂为25°~30°。对于相同节段下不同脱垂程度及椎管内位置,其头倾角差异具有统计学意义(P0.05)。[结论]术前可联合腰椎DR、CT、MRI初步测量并拟定穿刺进针的头倾角安全范围,即根据不同脱垂程度制定个性化手术入路,达到手术更加安全有效的目的。
[Abstract]:[objective] to measure the safe range of declination angle in the treatment of lumbar disc herniation through intervertebral foramen approach with TESSYS technique by using the image post-processing software (Vue PACS), and to measure the safety range of the puncture head angle in the treatment of lumbar intervertebral disc herniation through intervertebral foramen approach. Provide safe and accurate reference data for TESSYS technology; The safety range of head inclination angle measured before operation was used to verify the safety of TESSYS technique in the treatment of prolapse of lumbar intervertebral disc. [methods] A total of 59 patients with prolapse of lumbar intervertebral disc were selected from July 2013 to December 2016. The following indexes were measured on Vue PACS before operation: the degree of prolapse of nucleus pulposus, the depth of needle insertion by (MRI), puncture needle, and the determination of (CT), L _ (3), L _ (4), L_5~S_1 disc stenosis. Safe range of head tilt angle for severe prolapse (DR). Based on the measured range of head inclination, the desired puncture target and the efficiency and safety of the operation are determined. [results] according to the range of head inclination measured before operation, all the patients reached the preset position, and the effective rate and safety of operation were 90.6, 100, 100, L _ (4), respectively. The safe range of head inclination angle in L_5~S_1 intervertebral space was 15 掳~ 30 掳for central type and 40 掳~ 45 掳for severe prolapse. The degree of non-central prolapse was 35 掳~ 45 掳, and that of severe prolapse was 25 掳~ 30 掳. For the different prolapse degree under the same segment and the position in the spinal canal, the difference of the head inclination angle was statistically significant (P0.05). [conclusion] the safety range of head inclination angle of puncture needle can be preliminarily measured with lumbar DR,CT,MRI before operation, that is to say, individualized operative approach can be made according to different prolapse degree, so that the operation can be more safe and effective.
【作者单位】：新乡医学院;济宁医学院附属医院;重庆医科大学附属第二医院;
【分类号】：R687.3

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