Teaching experience of surface positioning technology for transforaminal endoscopic puncture guided by C-arm
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摘要:
目的 本文旨在探讨教学中应用C形臂X线透视下的经皮椎间孔镜的体表定位技术，评估该技术在脊柱外科及疼痛科椎间孔镜手术教学中的效果，尤其是针对初学者如何快速掌握定位穿刺技巧的实践经验。 方法 选择2024年11—12月于安徽医科大学第一附属医院疼痛科接受经皮椎间孔镜治疗的36例腰椎间盘突出症患者，根据所用技术不同分为YESS技术组、THESS技术组和可视化椎间孔成形术组，每组12例。通过C形臂X线透视对穿刺点进行定位，采用不同技术进行体表定位与穿刺，并评估每组的透视次数、穿刺时间及学员的教学满意度。 结果 使用可视化椎间孔成形术组的穿刺时间[(8.6±2.0)min]和透视次数[(6.0±1.9)次]均明显低于YESS技术组[(12.6±2.6)min和(9.6±2.1)次]和THESS技术组[(13.1±5.1)min和(10.7±2.6)次，P＜0.05]。此外，学员对可视化椎间孔成形术的教学满意度评分[(93.8±4.3)分]显著高于YESS技术组[(71.1±11.0)分]和THESS技术组[(63.3±7.1)分，F=47.590, P＜0.001]。 结论 C形臂X线透视引导下的经皮椎间孔镜定位穿刺技术，在腰椎间盘突出症的治疗中具有重要的临床价值，明显减少穿刺时间。通过简化的穿刺定位方法，初学者能够在较短时间内熟练掌握技术，显著减少了透视次数和手术时间，同时提升了学员的学习满意度。因此，该方法具有较高的推广价值，有助于减少患者的辐射暴露，并促进该技术在脊柱外科及疼痛科临床实践中的应用。 Abstract:Objective This study aims to explore the surface positioning technology of percutaneous transforaminal endoscopic lumbar discectomy under C-arm X-ray fluoroscopy in teaching, and to evaluate the effect of this technology in the teaching of transforaminal endoscopic lumbar discectomy in spinal surgery and pain department, especially the practical experience of how beginners can quickly master the positioning puncture skills. Methods Thirty-six patients with lumbar disc herniation who received percutaneous transforaminal endoscopic lumbar discectomy in the Department of Pain, the First Affiliated Hospital of Anhui Medical University from November to December 2024 were selected and divided into YESS technology group, THESS technology group and visualized foraminoplasty group according to the different technologies used, with 12 cases in each group. The puncture point was located by C-arm X-ray fluoroscopy, and different technologies were used for surface positioning and puncture. The number of fluoroscopy, puncture time, and teaching satisfaction of the trainees in each group were evaluated. Results The puncture time [(8.6±2.0) min] and the number of fluoroscopy [(6.0±1.9) times] of the group using visual foraminoplasty were significantly lower than those of the YESS group [(12.6±2.6) min and (9.6±2.1) times] and the THESS group [(13.1±5.1) min and (10.7±2.6) times, P < 0.05]. In addition, the trainees ' teaching satisfaction score for visual foraminoplasty (93.8±4.3) was significantly higher than that of the YESS group (71.1±11.0) and the THESS group (63.3±7.1, F=47.590, P < 0.001). Conclusion The percutaneous foraminoscopic puncture technique under the guidance of C-arm X-ray fluoroscopy has important clinical value in the treatment of lumbar disc herniation and significantly reduces the puncture time. Through the simplified puncture positioning method, beginners can master the technique in a short time, significantly reducing the number of fluoroscopy and operation time, while improving the learning satisfaction of trainees. Therefore, this method has a high promotion value, reducing the radiation exposure of patients and promoting the application of this technology in the clinical practice of spinal surgery and pain medicine. -
Key words:
- Lumbar disc herniation /
- Foreman intervertebral /
- Location /
- Puncture /
- C-arm X-ray /
- Lateral foreman technique
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图 1 采用YESS技术进行腰椎L4~5穿刺的靶点
注：A为C形臂下的X线侧位片；B为C形臂下的X线正位片。
Figure 1. Target points for lumbar L4-5 puncture using YESS technique
图 2 采用THESS技术进行腰椎L4~5穿刺的靶点
注：A为C形臂下的X线侧位片；B为C形臂下的X线正位片。
Figure 2. Target points for lumbar L4~5 puncture using THESS technique
图 3 采用可视化椎间孔成形术进行腰椎L5~S1穿刺的靶点
注：A为患者取侧卧位，在体表划定初步定位点并放置心电图电极，并调整电极位置使得金属投影位于L4椎体棘突后上缘；B为侧位片显示针尖抵达S1上关节突腹侧；C为正位片显示针尖抵达上关节突。
Figure 3. Target point of lumbar L5~S1 puncture using visualized foraminoplasty
表 1 3种穿刺技术穿刺时间、透视次数及教学满意度比较(x±s)
Table 1. Comparison of puncture time, number of fluoroscopy times, and teaching satisfaction among three puncture techniques(x±s)
组别 例数 透视次数 穿刺时长(min) 教学满意度评分(分) YESS技术组 12 9.6±2.1 12.6±2.6 71.1±11.0 THESS技术组 12 10.7±2.6 13.1±5.1 63.3±7.1 可视化椎间孔成形术组 12 6.0±1.9ab 8.6±2.0ab 93.8±4.3ab F值 14.620 5.836 47.590 P值 ＜0.001 0.007 ＜0.001 注：与YESS技术组比较，aP＜0.05；与THESS技术组比较，bP＜0.05。 
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