Cardiothoracic Surgery Department, The First People's Hospital of Fuyang, No. 429, Beihuan Road, Fuchun Street, Fuyang District, Hangzhou, 311400, Zhejiang, China.
The orthopaedic, Xiaoshan Hospital Affiliated to Wenzhou Medical University, Hangzhou, Zhejiang, China.
J Orthop Surg Res. 2024 Jan 12;19(1):55. doi: 10.1186/s13018-023-04270-x.
To explore the applicability of bone reamer and trephine for foraminoscopy in percutaneous endoscopic lumbar discectomy (PELD), and to provide a theoretical basis for foraminoplasty options in clinical practice.
This study was a prospective cohort study. Sixty-three consecutive patients who underwent PELD for lumbar disc herniation between May 2021 and July 2022 were analysed. Foraminoplasty were performed by bone reamer or trephine. The amount of bone removed and the foramen area enlarged during foraminoplasty by both tools were measured by 3D slicer and Digimizer software, and the numbers of fluoroscopic views were recorded.
The bone reamer removed less bone in the Superior Articular Process (SAP) than the trephine (t = 17.507, P < 0.001), and the area enlarged by the bone reamer was smaller than that of the trephine (t = 10.042, P = 0.002). The overall numbers of fluoroscopic views were significantly more in the bone reamer group than in the trephine group (t = 19.003, P < 0.001). In the bone reamer group, when the area of preoperative (FPZ) was no less than 54.55 mm, the mean number of fluoroscopic views significantly decreased (t = 14.443, P = 0.001).
Bone reamer was safer and trephine was more efficient for foraminoscopy in PELD. An area of preoperative (FPZ) of 54.55 mm can be used as a critical value: bone reamer reduced the risk for cases above the value, while trephine improved the efficiency for cases less than the value.
探讨骨钻和环锯在经皮内窥镜腰椎间盘切除术（PELD）中用于椎间孔成形术的适用性，为临床椎间孔成形术选择提供理论依据。
本研究为前瞻性队列研究。分析 2021 年 5 月至 2022 年 7 月期间因腰椎间盘突出症接受 PELD 治疗的 63 例连续患者。采用骨钻或环锯进行椎间孔成形术。使用 3D slicer 和 Digimizer 软件测量两种工具在椎间孔成形术中去除的骨量和扩大的椎间孔面积，并记录透视次数。
骨钻在关节突上（SAP）去除的骨量少于环锯（t=17.507，P<0.001），骨钻扩大的面积小于环锯（t=10.042，P=0.002）。骨钻组的总体透视次数明显多于环锯组（t=19.003，P<0.001）。在骨钻组中，当术前面积（FPZ）不小于 54.55mm 时，平均透视次数明显减少（t=14.443，P=0.001）。
骨钻在 PELD 中进行椎间孔成形术更安全，环锯更高效。术前面积（FPZ）为 54.55mm 可以作为一个临界值：骨钻降低了大于该值病例的风险，而环锯提高了小于该值病例的效率。
