透明全可视化工作通道辅助经椎板间入路脊柱内镜手术的临床疗效分析

doi:10.3969/j.issn.1006-5725.2025.12.013

摘要/Abstract

摘要：

目的创新性设计一种透明全可视化工作通道，探讨透明全可视化工作通道应用在经椎板间入路脊柱内镜手术（percutaneous endoscopic interlaminar discectomy， PEID）中治疗腰椎间盘突出症的临床疗效。方法纳入2023年9月至2024年9月接受PEID治疗腰椎间盘突出症的145例患者的病历资料，按照透明全可视化工作通道的使用情况分为透明通道组69例及金属通道组76例。比较两组患者一般资料、围手术期相关指标、手术并发症发生情况及术后临床疗效的差异。结果透明通道组的手术时间少于金属通道组，差异有统计学意义（P < 0.05）。透明通道组的术后住院时间及术中透视次数，与金属通道组差异无统计学意义（P > 0.05）。透明通道组术后发生1例下肢感觉异常；金属通道组术后发生7例下肢感觉异常，两组在术后并发症发生率方面差异无统计学意义（P > 0.05）。两组患者在工作通道放置时、探查神经时候肌电图电生理警报例数相比，差异无统计学意义（P > 0.05）；术中减压时可视化组肌电图电生理警报数8例少于金属通道组29例，差异有统计学意义（P < 0.05）。两组术后1、3、6个月及末次随访时的VAS评分、ODI评分较两组术前均有明显改善，两组差异无统计学意义。两组改良MacNab评定标准评估结果差异无统计学意义（P > 0.05）。结论透明全可视化工作通道应用于经椎板间入路脊柱内镜手术（PEID）可获得金属工作通道相同的临床疗效，可以明显减少神经根的刺激；透明工作通道镜下视野明显优于金属工作通道，可扩大视野，有利于有效观察并保护神经，增加手术的安全性。

关键词: 腰椎间盘突出症, 经皮内镜椎板间入路椎间盘切除术, 工作通道, 微创

Abstract:

Objective An innovative transparent full-visualization working channel was developed to investigate the clinical efficacy of applying a transparent full-visualization working channel in percutaneous endoscopic interlaminar discectomy （PEID） for the treatment of lumbar disc herniation. Methods The medical records of 145 patients who underwent PEID for lumbar disc herniation from September 2023 to September 2024 were included. These patients were classified into two groups based on the use of a transparent full-visualization working channel or a metal working channel： 69 cases in the transparent channel group and 76 cases in the metal channel group. A comparative analysis was carried out between the two groups， evaluating differences in baseline characteristics， surgical performance indicators， the incidence of postoperative complications， and overall treatment outcomes. Results The operative time in the transparent channel group was shorter than that in the metal channel group， and the difference was statistically significant （P < 0.05）. Regarding the length of postoperative hospital stays and the frequency of intraoperative fluoroscopy， no significant differences were observed between the transparent and metal channel groups （P > 0.05）. In the transparent channel group， postoperative sensory abnormalities in the lower extremities occurred in one patient， while in the metal channel group， seven patients experienced such issues. Nevertheless， this difference in complication rates did not reach statistical significance （P > 0.05）. Similarly， no significant differences were detected in EMG electrophysiological alerts during the placement of the working channel and nerve exploration between the two groups （P > 0.05）. However， during intraoperative decompression， the transparent channel group had 8 fewer EMG alarms compared to the metal channel group's total of 29， and this difference was statistically significant （P < 0.05）. Conclusions The application of a transparent fully visualized working channel in the transforaminal approach for PEID can achieve the same clinical efficacy as a metal working channel. Moreover， it can significantly reduce nerve root irritation. The microscopic field of view of the transparent working channel is notably superior to that of the metal working channel. This enhanced visibility expands the field of view， facilitating effective nerve observation and protection， and ultimately increasing the safety of the surgical procedure.

Key words: lumbar disc herniation, percutaneous endoscopic transforaminal discectomy, working channel, minimally invasive

中图分类号:

R681.57

史尉冉,黄莹,孙玛骥,袁峰. 透明全可视化工作通道辅助经椎板间入路脊柱内镜手术的临床疗效分析[J]. 实用医学杂志, 2025, 41(12): 1859-1866.

Weiran SHI,Ying HUANG,Maji SUN,Feng YUAN. Clinical efficacy analysis of transparent fully visualized working channel in percutaneous endoscopic interlaminar discectomy[J]. The Journal of Practical Medicine, 2025, 41(12): 1859-1866.

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项目	透明通道组（n = 69）	金属通道组（n = 76）	χ²/t值	P值
性别构成比（男/女）/例	33/36	36/40	0.003	0.956
年龄/岁	52.3 ± 14.2	51.6 ± 13.7	0.302	0.763
BMI/（kg/m²）	25.6 ± 4.7	25.3 ± 3.5	0.439	0.662
病程/月	12.8 ± 4.9	13.4 ± 5.3	0.706	0.482
病变节段/例			0.829	0.363
L₄/L₅	37	35
L₅/S₁	32	41

组别	平均手术时间/min	住院时间/d	术中透视次数
透明通道组（n = 69）	65.4 ± 7.2	2.9 ± 1.3	6.5 ± 1.3
金属通道组（n = 76）	68.3 ± 8.1	3.1 ± 1.7	6.6 ± 1.6
t值	2.269	0.790	0.411
P值	0.025	0.431	0.682

组别	放置工作通道时	术中减压时	探查神经时
透明通道组（n = 69）	69	8	69
金属通道组（n = 76）	76	29	76
χ²值	-	13.427	-
P 值	-	< 0.001	-

项目	透明通道组（n = 69）	金属通道组（n = 76）	χ²值	P值
感觉异常	1	7	2.823	0.093
术后复发	1	2	0.007	0.932

项目	透明通道组（n = 69）	金属通道组（n = 76）	t值	P值
VAS
术前 VAS	7.6 ± 1.2	7.8 ± 1.4	0.919	0.359
术后1个月	2.6 ± 0.8	2.7 ± 1.1	0.621	0.536
术后3个月	2.0 ± 0.6	2.1 ± 0.7	0.803	0.424
术后6个月	1.6 ± 0.6	1.7 ± 0.5	1.094	0.276
末次随访	0.7 ± 0.4	0.8 ± 0.6	1.169	0.245
ODI
术前ODI	54.3 ± 9.0	55.6 ± 9.4	0.849	0.398
术后1个月	15.2 ± 5.4	15.8 ± 5.7	0.649	0.517
术后3个月	10.8 ± 2.9	11.1 ± 3.2	0.589	0.557
术后6个月	8.1 ± 2.5	8.5 ± 2.8	0.904	0.368
末次随访	6.7 ± 2.3	7.1 ± 2.7	0.955	0.341