本文選題：腰椎退行性疾病 + 定位板�。� 參考：《中國脊柱脊髓雜志》2017年04期

【摘要】：目的 :探討新型定位板應(yīng)用在腰椎后外側(cè)經(jīng)椎間孔腰骶神經(jīng)根封閉術(shù)的術(shù)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,其中單節(jié)段腰椎間盤突出癥51例,單節(jié)段腰椎管狹窄癥42例,經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)后癥狀復(fù)發(fā)9例,采用隨機數(shù)字表隨機分入兩組后行腰椎后外側(cè)經(jīng)椎間孔腰骶神經(jīng)根封閉術(shù)。A組54例,手術(shù)節(jié)段為L3/4 8例、L4/5 28例、L5/S1 18例,采用新型定位板術(shù)前定位;B組48例,手術(shù)節(jié)段為L3/4 8例、L4/5 26例、L5/S1 14例,采用金屬定位針術(shù)前定位。兩組患者年齡、性別、手術(shù)節(jié)段、保守治療時間均無統(tǒng)計學(xué)差異(P0.05)。記錄兩組術(shù)前的透視次數(shù)和準備時間、穿刺時間、穿刺期透視次數(shù)、手術(shù)并發(fā)癥、穿刺術(shù)后1h穿刺區(qū)疼痛VAS評分,并進行統(tǒng)計學(xué)分析。結(jié)果:A組術(shù)前的準備時間為5.2±1.0min、透視次數(shù)為1.1±0.3次,穿刺時間9.6±2.2min,穿刺期透視次數(shù)3.1±1.0次;B組術(shù)前的準備時間為10.7±2.3min、透視次數(shù)為3.8±1.2次,穿刺時間16.3±3.3min,穿刺期透視次數(shù)4.6±0.6次,兩組比較均有統(tǒng)計學(xué)差異(P0.05),A組均優(yōu)于B組。兩組均未出現(xiàn)椎管內(nèi)血腫、腹腔臟器損傷、下肢感覺和運動功能異常,B組出現(xiàn)硬膜刺裂1例(1/48)、穿刺區(qū)域皮下血腫4例(4/48),兩組并發(fā)癥發(fā)生率無統(tǒng)計學(xué)差異(P0.05);術(shù)后1h穿刺區(qū)域疼痛VAS評分,A組為3.4±0.5分,B組為5.0±0.9分,有統(tǒng)計學(xué)差異(P0.05)。結(jié)論:對于經(jīng)椎間孔腰骶神經(jīng)根封閉術(shù),使用新型定位板術(shù)前定位,并進行穿刺路徑設(shè)計,可減少術(shù)前透視次數(shù)、術(shù)前準備時間,有助于縮短穿刺時間及穿刺期透視次數(shù),定位板具有使用方便、可靠、有效等優(yōu)點。
[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 鹵1.0 min, the fluoroscopy time was 1.1 鹵0.3, the puncture time was 9.6 鹵2.2 min, the puncture time was 3.1 鹵1.0 times, the preoperative preparation time was 10.7 鹵2.3 min, the fluoroscopy time was 3.8 鹵1.2, the puncture time was 16.3 鹵3.3 min, and the puncture period was 4.6 鹵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 鹵0.5 min (P < 0.05), and that in group B was 5.0 鹵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.
【作者單位】： 解放軍總醫(yī)院骨二科;
【分類號】：R687.3

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