3D打印辅助椎间孔镜髓核摘除手术治疗腰椎间盘突出症的疗效研究
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摘要
目的探讨3D打印辅助椎间孔镜髓核摘除手术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法选择2015-05-2017-05,于本院治疗的74例LDH患者,随机均分为观察组与对照组:对照组患者采用常规椎间孔镜髓核摘除手术治疗,观察组在3D打印辅助下完成。比较两组患者手术时间、穿刺次数等手术指标,随访12～20个月,对比两组临床疗效,并记录并发症发生情况。结果观察组手术时间、穿刺次数、透视次数均显著低于对照组,差异有统计学意义(P<0.05);两组治疗后VAS评分、ODI评分均显著降低,但术后7 d观察组显著低于对照组,差异有统计学意义(P<0.05),术后3个月、末次随访时组间差异无统计学意义(P>0.05);观察组与对照组手术优良率分别为89.19%与86.49%,组间差异无统计学意义(P>0.05);观察组术后并发症发生率为8.11%,显著低于对照组的18.92%,差异有统计学意义(P<0.05)。结论 3D打印辅助椎间孔镜髓核摘除手术治疗LDH,能降低手术及透视时间,减少穿刺次数,术后短期疼痛、腰椎功能改善更佳,能降低并发症发生。
Objective To investigate the therapeutic effect of 3D printing-assisted transforaminal endoscopic lumbar discectomy on lumbar disc herniation. Methods 74 LDH patients treated in our hospital from May 2015 to May 2017 were selected and randomly divided into two groups. The control group received the transforaminal endoscopic lumbar discectomy, while the observation group underwent the surgery assisted by 3D printing technology. Then the operation time, puncture times, pain degrees and lumbar function assessed by Oswestry disability index(ODI) and visual analogue scale(VAS), operation effect evaluated by modified Macnab criteria,and complications of two groups were recorded. Results The operation time, puncture times and fluoroscopy frequency of the observation group were significantly lower than those of the control group(P<0.05). The scores of VAS and ODI in both groups were decreased, and were lower in the observation group than in the control group at the postoperative 7 days(P<0.05), while no difference was found at the postoperative 3 months and last follow-up(P>0.05). The excellent and good rates of operation in the observation group and the control group were 89.19% and 86.49% respectively, with no statistic difference(P >0.05). The incidence of postoperative complications in the observation group was lower than that in the control group(8.11% vs 18.92%,P<0.05). Conclusion 3D printing assisted foraminoscopic nucleus pulposus removal for LDH can reduce the time of operation and fluoroscopy, reduce the number of punctures, improve short-term pain and lumbar function, and reduce complications.
Objective To investigate the therapeutic effect of 3D printing-assisted transforaminal endoscopic lumbar discectomy on lumbar disc herniation. Methods 74 LDH patients treated in our hospital from May 2015 to May 2017 were selected and randomly divided into two groups. The control group received the transforaminal endoscopic lumbar discectomy, while the observation group underwent the surgery assisted by 3D printing technology. Then the operation time, puncture times, pain degrees and lumbar function assessed by Oswestry disability index(ODI) and visual analogue scale(VAS), operation effect evaluated by modified Macnab criteria,and complications of two groups were recorded. Results The operation time, puncture times and fluoroscopy frequency of the observation group were significantly lower than those of the control group(P<0.05). The scores of VAS and ODI in both groups were decreased, and were lower in the observation group than in the control group at the postoperative 7 days(P<0.05), while no difference was found at the postoperative 3 months and last follow-up(P>0.05). The excellent and good rates of operation in the observation group and the control group were 89.19% and 86.49% respectively, with no statistic difference(P >0.05). The incidence of postoperative complications in the observation group was lower than that in the control group(8.11% vs 18.92%,P<0.05). Conclusion 3D printing assisted foraminoscopic nucleus pulposus removal for LDH can reduce the time of operation and fluoroscopy, reduce the number of punctures, improve short-term pain and lumbar function, and reduce complications.
引文
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[2]杨长征,裴晓东,柴红生,等.基于3D打印的腰椎椎弓根螺钉治疗腰椎退变性疾病的临床应用[J].临床医学研究与实践,2016,1(24):1-3.
[3] Greguri T, Trkulja V, Baudoin T, et al. Differences in the SinoNasal Outcome Test 22 and visual analog scale symptom scores in chronic rhinosinusitis with and without nasal polyps[J]. American Journal of Rhinology&Allergy, 2016, 30(2):107-112.
[4] van Hooff ML, Mannion AF, Staub LP, et al. Determination of the oswestry disability index score equivalent to a"satisfactory symptom state"in patients undergoing surgery for degenerative disorders of the lumbar spine-A spine tango registry-based study[J]. Spine Journal, 2016, 16(10):1221-1230.
[5]杨波,万盛钰,曾勉东,等. Dynesys系统治疗腰椎退行性疾病对邻近节段的影响[J].中国组织工程研究, 2013, 17(17):3057-3064.
[6]张树芳,钟红发,陈荣春,等.基于3D打印模型确定经椎弓根椎体截骨治疗脊柱后凸畸形的最佳选择[J].中国组织工程研究,2016, 20(53):7966-7972.
[7] Javan R, Zeman M N. A Prototype Educational Model for Hepatobiliary Interventions:Unveiling the Role of Graphic Designers in Medical 3D Printing[J]. Journal of Digital Imaging,2017, 31(9):1-11.
[8]赖居易,何升华,孙志涛,等. 3D打印技术在腰椎经皮椎间孔镜髓核摘除术中的应用[J].广东医学, 2016, 37(s2):137-139.
[9] Ilie P C, Farquhar L, Calleja R, et al. P06 The value of personalised3D printing model of kidney stones for patients requiring surgical treatment[J]. European Urology Supplements, 2018, 17(4):e2011-2012.
[10]王威,黎清波,蔡磊,等.基于3D打印导航模块腰椎椎弓根螺钉置入的精确性[J].中国组织工程研究, 2018, 22(7):1114-1119.