Department of Orthopedics, Jiaxing Key Laboratory for Minimally Invasive Surgery in Orthopedics & Skeletal Regenerative Medicine, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China (mainland).
Med Sci Monit. 2023 Mar 22;29:e937692. doi: 10.12659/MSM.937692.
BACKGROUND Foraminal puncture is a key step in foraminal endoscopic surgery, but the radiation dosage poses a clinical risk to patients. To reduce the radiation dosage, we investigated the feasibility and clinical effect of endoscopic transforaminal puncture through the use of the musculoskeletal ultrasound-guided lumbar percutaneous posterolateral approach. MATERIAL AND METHODS Retrospective data of 80 lumbar percutaneous posterolateral approach endoscopic surgery patients from March 2018 to June 2021 were analyzed. The clinical efficacy was assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) during the follow-up. RESULTS Between the musculoskeletal ultrasound-guided group and the C-arm X-ray machine fluoroscopy group, the puncture time of the musculoskeletal ultrasound-guided group was significantly shorter than that of the C-arm X-ray machine fluoroscopy group (t=13.113, P=0.010). The radiation received in the ultrasound guidance group was significantly less than in the C-arm X-ray group. There was no difference in ODI values between the 2 groups before surgery (t=0.195, P=0.286), 3 months after surgery (t=0.235, P=0.092), and 1 year after surgery (t=0.168, P=0.173). There was no significant difference in VAS scores between the 2 groups before surgery (t=0.715, P=0.610), 3 months after surgery (t=0.367, P=0.192), and 1 year after surgery (t=0.496, P=0.390). CONCLUSIONS Our data demonstrate that musculoskeletal ultrasound can accurately guide the lumbar percutaneous posterolateral approach for endoscopic foraminal puncture, which can significantly reduce the puncture time and the amount of X-ray radiation.
经皮椎间孔入路内窥镜手术中，椎间孔穿刺是关键步骤，但射线剂量会对患者造成临床风险。为降低射线剂量，我们研究了肌骨超声引导下腰椎经皮后外侧入路内窥镜经椎间孔穿刺的可行性和临床效果。
回顾性分析 2018 年 3 月至 2021 年 6 月间 80 例腰椎经皮后外侧入路内窥镜手术患者的临床资料，随访时采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评估临床疗效。
肌骨超声组与 C 臂 X 线机透视组相比，肌骨超声组穿刺时间明显短于 C 臂 X 线机透视组（t=13.113，P=0.010），接受的射线辐射量明显小于 C 臂 X 线透视组。两组患者术前 ODI 值差异无统计学意义（t=0.195，P=0.286），术后 3 个月（t=0.235，P=0.092）和术后 1 年（t=0.168，P=0.173）差异亦无统计学意义。两组患者术前 VAS 评分差异无统计学意义（t=0.715，P=0.610），术后 3 个月（t=0.367，P=0.192）和术后 1 年（t=0.496，P=0.390）差异亦无统计学意义。
我们的数据表明，肌骨超声可准确引导腰椎经皮后外侧入路内窥镜椎间孔穿刺，显著缩短穿刺时间和减少 X 射线辐射量。
