Minimally Invasive Full-endoscopic Posterior Cervical Foraminotomy and Discectomy: Introducing a Simple and Useful Localization Technique of the "V" Point.
Minimally Invasive Full-endoscopic Posterior Cervical Foraminotomy and Discectomy: Introducing a Simple and Useful Localization Technique of the "V" Point.
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DOI：
10.1111/os.13476
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发表时间：
2022-10
影响因子：
2.1
通讯作者：
Lao, Lifeng
中科院分区：
文献类型：
--
作者：
Zhong, Guibin;Feng, Fan;Su, Xinjin;Chen, Xiuyuan;Zhao, Junduo;Shen, Hongxing;Chen, Jianwei;Lao, Lifeng
关键词：
全内窥镜颈椎后路椎间孔切开术和椎间盘切除术（FPCD）的传统V点定位技术需要重复透视，尤其是对于颈短而粗的患者。针对这一问题，本研究旨在介绍一种新的V点定位技术，并进一步评价其有效性。在前后位透视下，将克氏针插入并固定在椎弓根眼，然后迅速建立工作通道。本研究纳入了34例接受新技术辅助下微创FPCD的患者。收集并分析临床和影像学资料，包括放射剂量、手术时间、体位时间、颈臂疼痛视觉模拟评分（VAS）、颈部残疾指数（NDI）评分、手术节段Cobb角和颈椎活动度。所有手术均顺利完成，无医源性神经或血管损伤。没有患者需要转入开放手术或翻修手术。平均辐射剂量为1.68 ± 0.36mSv。观察到的平均定位时间为10.68 ± 5.42 min，平均手术时间为81.18 ± 10.87 min。随着患者数量的增加，手术时间明显缩短。第一个四分位数病例的手术时间（96.22 ± 10.36 min）与最后一个四分位数病例的手术时间（75.00 ± 3.84 min）差异有统计学意义（t = 4.82，P < 0.001）。术后颈部和手臂疼痛的VAS评分以及NDI评分显著改善（P VAS-颈部<0.0001，P VAS-手臂<0.0001，P NDI<0.0001）。按MacNab标准评定，优良率为91.17%。手术节段的Cobb角和颈椎活动度术后均显著改善（t = 2.846，P OA = 0.015; t = 2.232，P ROM−CA = 0.026）。新的图像辅助V点定位技术简单实用，辐射暴露少，定位时间短。新技术辅助的FPCD可能是适当选择患者的安全有效的替代方案。在此，我们介绍了一种新的定位技术，即在A/P X线引导下，通过将克氏针固定在椎弓根眼处，可以轻松快速地确定V点，并且可以轻松地沿克氏针沿着插入工作管，避免重复透视。
Conventional localization technique of V point for full‐endoscopic posterior cervical foraminotomy and discectomy (FPCD) required repeated fluoroscopies, especially in patients with short and thick necks. To address this issue, the present study aimed to introduce a new localization technique of V point, and further evaluate its efficacy. A K‐wire was inserted and fixed at the pedicle eye under A/P fluoroscopy, then a working channel was established quickly along with it. Thirty‐four patients who underwent minimally invasive FPCD assisted by the new technique were included in this study. The clinical and radiological data were collected and analyzed, including radiation dose, operative time, positioning time, visual analog scale (VAS) for neck and arm pain, neck disability index (NDI) scores, Cobb angle of operative level and range of motion of the cervical spine. All operations were performed successfully, and no iatrogenic nerve or vascular injury occurred. None of the patients needed to be transferred to open surgery or revision surgery. The mean radiation dose was found to be1.68 ± 0.36 mSv. The mean positioning time observed was 10.68 ± 5.42 min and the average operation time was 81.18 ± 10.87 min. The operation time significantly declined as the number of patients increased. A significant difference in operation time between the first (96.22 ± 10.36 min) and last quartile (75.00 ± 3.84 min) of cases was observed (t = 4.82, P < 0.001). The VAS scores for neck and arm pain, and NDI scores were significantly improved after surgery (P VAS−Neck<0.0001, P VAS−Arm<0.0001, P NDI<0.0001). Based on MacNab criteria, the excellent plus good rate was 91.17%. The Cobb angle of operative level and range of motion of the cervical spine were significantly improved postoperatively (t = 2.846, P OA = 0.015; t = 2.232, P ROM−CA = 0.026). The new image‐assisted V point localization technique is simple and useful with little radiation exposure and short positioning time. FPCD assisted by the new technique could be a safe and effective alternative on properly selected patients. Here, we introduced a new localization technique that the V point could be easily and quickly determined by fixing a k‐wire at the pedicle eye under the A/P X‐ray guidance, and the working tube could easily be inserted along the K‐wire, avoiding repeated fluoroscopies.
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DOI：
10.2106/00004623-199907000-00008
发表时间：
1999-07-01
影响因子：
5.3
作者：
Hermantin, FU;Peters, T;Kambin, P
通讯作者：
Kambin, P
影响因子：
3
作者：
Fountas, Kostas N.;Kapsalaki, Eftychia Z.;Robinson, Joe S.
通讯作者：
Robinson, Joe S.
影响因子：
2.8
作者：
Fraser, Jusun F.;Haertl, Roger
通讯作者：
Haertl, Roger
影响因子：
2.8
作者：
Kelly, Michael P.;Eliasberg, Claire D.;SooHoo, Nelson F.
通讯作者：
SooHoo, Nelson F.
影响因子：
1.9
作者：
Schroeder, Gregory D.;Kurd, Mark F.;Hilibrand, Alan S.
通讯作者：
Hilibrand, Alan S.