METHODS: The study included 56 consecutive patients with single segment massive LDH who underwent decompression assisted by a 3D exoscope from October 2019 to October 2022 at a university hospital. The analysis was based on comparison of perioperative metrics including decompression time, estimated blood loss (EBL) during decompression and postoperative length of stay (PLS); clinical outcomes including assessment using the visual analogue scale (VAS) and the Oswestry disability index (ODI); and incidence of reoperation and complications.
RESULTS: The mean decompression time was 28.35 ± 8.93 min (lumbar interbody fusion (LIF)) and 15.50 ± 5.84 min (fenestration discectomy (LOVE surgery)), the mean EBL during decompression was 42.65 ± 12.42 ml (LIF) and 24.32 ± 8.61 ml (LOVE surgery), and the mean PLS was 4.56 ± 0.82 days (LIF) and 2.00 ± 0.65 days (LOVE surgery). There were no complications such as cerebrospinal fluid leakage, nerve root injury and epidural hematoma. All patients who underwent decompression assisted by a 3D exoscope were followed up for 6 months. At the last follow-up, the VAS and ODI scores were significantly improved from the preoperative period to the last follow-up (P < 0.05).
CONCLUSIONS: A 3D exoscope provides a visually detailed, deep and clear surgical field, which makes decompression safer and more effective and reduces short-term complications. A 3D exoscope may be a good assistance tool during decompression for single-segment massive LDH.
方法:该研究纳入了56例连续的单节段大量LDH患者,这些患者于2019年10月至2022年10月在大学医院接受了3D外镜辅助减压。分析基于围手术期指标的比较,包括减压时间,减压期间估计的失血量(EBL)和术后住院时间(PLS);临床结果,包括使用视觉模拟评分法(VAS)和Oswestry残疾指数(ODI)进行评估;以及再次手术和并发症的发生率。
结果:平均减压时间为28.35±8.93分钟(腰椎椎间融合术(LIF))和15.50±5.84分钟(开窗椎间盘切除术(LOVE手术)),减压期间平均EBL为42.65±12.42ml(LIF)和24.32±8.61ml(LOVE手术),平均PLS为4.56±0.82天(LIF)和2.00±0.65天(LOVE手术)。无脑脊液漏等并发症,神经根损伤和硬膜外血肿。所有接受3D外镜辅助减压的患者均随访6个月。在最后一次随访中,术前至末次随访,VAS和ODI评分均有明显改善(P<0.05)。
结论:3D外镜提供了视觉上详细的,深而清晰的手术野,这使得减压更安全,更有效,并减少短期并发症。在单段大量LDH的解压缩期间,3D外镜可能是一个很好的辅助工具。