改良TESSYS技术对腰椎...部活动度及脊柱稳定性的影响_武刚伟.pdf

临床医学研究与实践2023 年 3 月第 8 卷第 9 期临床医学Effects of modified TESSYS technology on waist mobility and spinal stabilityin patients with lumbar disc herniationWU Gangwei1,SHI Lei2*,DU Heng3(1.No.1 Orthopaedics Department,Xian Central Hospital,Xian 710003;2.Pain Department,Xian Central Hospital,Xian 710003;3.Orthopaedics Department,the First Affiliated Hospital of Xian Jiaotong University,Xian 710003,China)ABSTRACT:Objective To investigate the effects of modified transforaminal endoscopic spine system(TESSYS)technologyon waist mobility and spinal stability in patients with lumbar disc herniation(LDH).Methods The clinical data of 110patients with LDH admitted in the pain department from February 2019 to February 2022 were retrospectively analyzed.According to different operation methods,all patients were divided into control group and study group,with 55 cases ineach group.The control group was treated with microendoscopy technology,and the study group was treated with modifiedTESSYS technology.The surgical indexes,waist mobility,spinal stability and lumbar function before and after surgery werecompared between the two groups.Results The incision length of the study group was smaller than that of the controlgroup,the surgery time,bed time and hospital stay were shorter than those of the control group,and the intraoperativeblood loss was less than that of the control group(P0.05).One month after surgery,the lumbar curvature,lumbar flexionrange,posterior extension of lumbodorsi muscle and flexor/extensor(F/E)value of the study group were significantly betterthan those of the control group(P0.05).One month after surgery,the lumbar lordosis angle,lumbar bone inclination angle,sagittal plane balance and maxilloeyebrow angle of the study group were significantly better than those of the controlgroup,and the differences were statistically significant(P0.05).Three months after surgery,the Roland-Morris DisabilityQuestionnaire(RMQ)and Visual Analogue Scale(VAS)scores of the study group were lower than those of the controlgroup,Japanese Orthopaedic Association(JOA)score was higher than that of the control group,range of motion(ROM)wasgreater than that of the control group,and the differences were statistically significant(P0.05).Conclusion Compared withmicroendoscopy technology,modified TESSYS technology has more advantages in the treatment of LDH patients,with lesstrauma and intraoperative bleeding,it is conducive to improving waist mobility and restoring spinal stability,thus betterimproving lumbar function,which is worthy of clinical application and promotion.KEYWORDS:modified transforaminal endoscopic spine system technology;lumbar disc herniation;microendoscopytechnology;waist mobility;spinal stability;lumbar function改良 TESSYS 技术对腰椎间盘突出症患者腰部活动度及脊柱稳定性的影响武刚伟1，师磊2*，杜恒3（1.西安市中心医院骨一科，陕西 西安，710003；2.西安市中心医院疼痛科，陕西 西安，710003；3.西安交通大学第一附属医院骨科，陕西 西安，710003）摘要：目的 探讨改良经椎间孔脊柱内镜系统（TESSYS）技术对腰椎间盘突出症（LDH）患者腰部活动度及脊柱稳定性的影响。方法 回顾性分析 2019 年 2 月至 2022 年 2 月疼痛科收治的 110 例 LDH 患者的临床资料，根据不同术式将患者分为对照组和研究组，各 55 例。对照组给予椎间盘镜技术治疗，研究组给予改良 TESSYS 技术治疗。比较两组患者的手术指标以及手术前、后的腰部活动度、脊柱稳定性及腰椎功能。结果 研究组的切口长度小于对照组，手术时间、卧床时间及住院时间短于对照组，术中出血量少于对照组（P0.05），可进行比较。本研究经医院伦理委员会审批；患者自愿签署手术知情同意书。1.2 纳入及排除标准纳入标准：伴有腰腿痛、下肢麻木等症状，经影像学检查符合 腰椎间盘突出症诊疗指南6中相关标准；符合手术治疗指征；美国麻醉医师协会（American Society ofAnesthesiologists,ASA）分级级；年龄 3075 岁；麻醉及手术耐受性良好；无严重器质性病变；意识清晰，认知功能及依从性良好。排除标准：既往有腰椎手术史、腰椎椎管狭窄、脊柱不稳或滑脱、凝血机制异常；存在手术禁忌证；合并严重的器官功能障碍、代谢性骨病、免疫缺陷性疾病、精神认知障碍、感染性疾病；临床资料不全。1.3 方法对照组患者接受椎间盘镜技术治疗。患者硬膜外麻醉后取俯卧位，垫空腹部使腰椎后凸，选择美国 Medtronic 公司提供的 METRx 椎间盘镜摄像系统，采用穿刺针在患侧椎间隙棘突连线旁 1 cm 处垂直穿刺进入椎旁肌，之后在穿刺点做 2 cm 左右纵向切口，沿穿刺通道置入扩张器至椎板，再建立工作通道并置入内镜进行固定，使用髓核钳及枪钳依次去除椎板及小关节突内侧表面软组织，确认椎板及椎板间隙后切除黄韧带，进入椎管，通过移动内镜并使用剥离器剥离神经根及硬膜囊，充分暴露突出的椎间盘后切除突出的椎间盘及髓核，采用生理盐水反复冲洗切口后，常规进行止血、缝合切口并包扎，术毕。研究组患者接受改良 TESSYS 技术治疗。选择德国Joimax 公司提供的 TESSYS。麻醉方式、体位及术前准备同对照组，在 C 臂机透视下明确穿刺点，使用 18 号穿刺针进行穿刺并导入 22 号穿刺针，经椎间孔插入椎间盘，注入13 mL 碘海醇与亚甲蓝混悬液，观察椎间盘破裂情况。置入导丝并做 1 cm 左右小切口，沿导丝置入扩张套管，采用扩张导棒扩张工作通道直至可置入 7.5 mm 直径的扩张导管，连接内镜系统，调整影像系统确保术野清晰，采用髓核钳摘除突出的椎间盘，松解神经根及硬膜囊后止血，撤除内镜系统及工作导管，缝合切口并包扎，术毕。所有患者术后均遵医嘱应用镇痛、抗感染、活血消肿药物进行支持治疗，待患者病情稳定后指导其佩戴腰围下床活动，进行相应的康复锻炼。1.4 观察指标及评价标准1.4.1 手术相关指标：切口长度、手术时间、术中出血量、卧床时间及住院时间。1.4.2 腰部活动度。在术前及术后 1 个月分别采用美国 GE公司提供的 VARiAN 500 mA X 线扫描仪及 Seze 测量法7计算腰椎曲度及腰屈曲范围；采用美国 Biodex 公司提供的 System 4 Pro 多关节等速肌力测试训练系统测量腰背肌后伸活动度及腰肌背屈/伸肌比值（flexor/extensor,F/E）。1.4.3 脊柱稳定性。在术前及术后 1 个月分别采用飞利浦Bucky Diagnost FS 型 X 线扫描仪测量腰椎前凸角、腰骨倾斜角、矢状面平衡及颌眉角。1.4.4 腰椎功能。术前及术后 3 个月，采用 Roland-Morris功能障碍调查表（Roland-MorrisDisabilityQuestionnaire,RMQ）、日本骨科协会（Japanese Orthopaedic Association,JOA）下腰痛评分系统、视觉模拟疼痛评分量表（Visual Analogue Scale,VAS）及腰椎关节活动度（range of motion,ROM）进行评价。RMQ 包括睡眠、站立、行走、日常活动、穿衣等 8 个方面，满分 24 分，评分越低表示腰椎功能越好；JOA 评分为029 分，评分越高表示腰椎功能越好；VAS 评分为 010 分，评分越低表示腰椎疼痛越轻微；ROM 即过伸位与过屈位X 线片同一椎间隙上位椎体下终板与下位椎体上终板切2-临床医学研究与实践2023 年 3 月第 8 卷第 9 期表 1两组患者的手术相关指标比较（n=55，x?s）组别切口长度（cm）手术时间（min）术中出血量（mL）卧床时间（d）住院时间（d）研究组0.830.2255.346.8723.147.795.281.325.831.43对照组1.910.4670.5311.4694.3620.588.762.179.162.25t-15.708-8.431-24.003-10.161-9.263P0.0000.0000.0000.0000.000表 2两组患者术前、术后 1 个月的腰部活动度比较（n=55，x