新型三维穿刺定位器的设计及其在经椎间孔入路经皮内窥镜技术中的尸体应用

摘要

Objective To introduce a novel three-dimensional locator and investigate its on the puncture accuracy and fluoroscopic radiation of transforaminal percutaneous endoscopic technique. Methods Puncture procedure of transforaminal percutaneous endoscopic technique were performed on 10 thawed fresh frozen cadaver specimens. A senior doctor conducted punctures on the left side of L4/L5 and L5/S1 level with novel three-dimensional locator(group A),and on the right side of L4/L5 and L5/S1 level with traditional positioning method(group B). The anteroposterior and lateral fluoroscopy frequency,puncture fluoroscopy,cumulative radiation dose were recorded,and compared between the groups. Results The puncture was successful at L4/L5 level in 10 specimens and at L5/S1 level in 9(1 specimen was unable to complete the puncture because of the high iliac bone). There were significant differences in fluoroscopy frequency,puncture fluoroscopy,and cumulative radiation dose at L4/L5 and L5/S1 levels between 2 groups(P < 0.05). The novel three-dimensional locator improved the puncture accuracy of 50.00%-51.34%,and reduce the radiation doge of 38.78%- 41.06%. Conclusion The novel three-dimensional locator could significantly increase puncture accuracy,reduce fluoroscopy frequency and radiation dose in puncture procedure of transforaminal percutaneous endoscopic technique.%目的 初步探讨新型三维穿刺定位器对经椎间孔入路经皮内窥镜技术穿刺准确性和透视辐射量的影响.方法 在10具新鲜解冻尸体标本上进行穿刺操作.由一名高年资医师使用新型三维穿刺定位器在尸体左边的L4/L5和L5/S1节段进行定位穿刺(A组);由同一名医师用传统方法在尸体右边L4/L5和L5/S1节段进行定位穿刺(B组).记录每个节段操作的前后位和侧位透视次数、穿刺次数及辐射剂量,并进行组间比较.结果 10具标本L4/L5节段穿刺顺利完成;9具标本L5/S1节段穿刺顺利完成,1具因髂嵴太高等原因无法完成穿刺.在L4/L5和L5/S1节段,A组在透视次数、穿刺次数和辐射剂量上均优于B组,差异有统计学意义(P<0.05).新型三维穿刺定位器能提高50.00%~51.34%的穿刺准确率,降低38.78%~41.06%的辐射剂量.结论 在经椎间孔入路经皮内窥镜技术中,新型三维穿刺定位器可有效提高定位穿刺时的准确性,减少透视次数和辐射剂量.