Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China.
Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China.
World Neurosurg. 2021 May;149:e292-e297. doi: 10.1016/j.wneu.2021.02.033. Epub 2021 Feb 18.
Percutaneous endoscopic lumbar discectomy (PELD) has been widely used, before which foraminoplasty is necessary to widen the foramen for subsequent procedures. However, the learning curve of this technology is high, as the use of traditional reamers requires repeated intraoperative fluoroscopy. We sought to compare the clinical outcomes by using the visualized and traditional reamers in PELD foraminoplasty for the treatment of lumbar disc herniation.
Eighty patients with lumbar disc herniation who were treated with PELD between 1 January 2017 and 1 January 2019 were retrospectively reviewed. The patients were randomly divided into 2 groups (40 patients in the Visualized Bone Reamer group) and (40 patients in the Traditional Bone Reamer group). Intraoperative fluoroscopy time, cannulation introduction time, visual analog scale, and Macnab criteria score were compared between the 2 groups.
The mean follow-up durations were 17.41 ± 1.47 and 18.37 ± 1.69 months in the visualized and traditional groups, respectively. The average cannulation introduction time and intraoperative fluoroscopy times in the visualized group is significantly lower than those in traditional group (29.20 ± 3.31 vs. 39.85 ± 3.98 minutes, P < 0.001; and 12.30 ± 2.38 vs. 20.65 ±3.51 seconds, P < 0.001, respectively). One patient in the traditional group required reoperation, and no complications occurred in the visualized group. There were no severe durotomies or vascular or visceral injuries.
Full-endoscopic foraminoplasty using a visualized reamer is safe and effective and can decrease intraoperative fluoroscopy time in PELD.
经皮内窥镜腰椎间盘切除术（PELD）已被广泛应用，在此之前需要进行椎间孔成形术以扩大椎间孔，以便后续操作。然而，该技术的学习曲线较高，因为传统扩孔器的使用需要在术中反复进行透视。我们旨在比较可视化和传统扩孔器在经皮内窥镜腰椎间盘切除术椎间孔成形术中治疗腰椎间盘突出症的临床效果。
回顾性分析 2017 年 1 月 1 日至 2019 年 1 月 1 日期间采用 PELD 治疗的 80 例腰椎间盘突出症患者。将患者随机分为 2 组（可视化骨扩孔器组 40 例，传统骨扩孔器组 40 例）。比较两组患者的术中透视时间、置管导入时间、视觉模拟评分和 Macnab 标准评分。
可视化组和传统组的平均随访时间分别为 17.41 ± 1.47 个月和 18.37 ± 1.69 个月。可视化组的平均置管导入时间和术中透视时间明显低于传统组（29.20 ± 3.31 分钟比 39.85 ± 3.98 分钟，P < 0.001；12.30 ± 2.38 秒比 20.65 ± 3.51 秒，P < 0.001）。传统组中有 1 例患者需要再次手术，而可视化组中无并发症发生。无严重硬脊膜撕裂或血管、内脏损伤。
经皮内窥镜下使用可视化扩孔器进行椎间孔成形术是安全有效的，可以减少 PELD 术中透视时间。
