背景:脊髓刺激是一种已建立的技术,其中在脊髓硬膜外腔内策略性地植入多种电极类型以进行神经调节。传统的经皮穿刺圆柱形电极(PE)主要由介入医生在辐射监测下利用经皮技术植入,这是一个非可视化的过程。
目的:我们的研究旨在评估经皮内镜辅助可视化植入PE的可行性,描述其与传统方法相比的具体优点和缺点。
方法:机构审查委员会编号B2023-056的实验室研究:临床解剖学研究中心,复旦大学。
方法:本研究对8具新鲜采购的成年尸体(4名女性和4名男性)进行手术。他们被分为A组或B组,每个包括4具尸体。A组接受内窥镜辅助PE植入,而B组遵循常规PE植入途径。两组插入针放置(OTNP)的手术时间,总手术时间(TOT),插入针放置的透视时间(FTNP),记录和分析总透视时间(TFT).此外,我们系统检查了PE的精确定位和任何随后的并发症.
结果:A组和B组均成功执行了所有预定的手术步骤。总共植入了16个PE(每个尸体中的双电极):8个使用经皮内窥镜辅助的可视化方法(A组)和8个通过传统方法(B组)。A组OTNP的平均值±SD持续时间,TOT,FTNP,TFT为10.25±1.03分钟,31.63±5.87分钟,4.58±1.35秒,和43.73±14.46秒,分别。相比之下,B组表现为11.55±2.81分钟的平均±SD时间,44.75±7.85分钟,23.53±4.16秒,和66.30±6.35秒对于相同的度量。组间OTNP和TOT没有明显的统计学差异。然而,与B组相比,A组显示FTNP和TFT的持续时间减少。通过荧光镜检查验证了PE的最佳位置。没有记录的硬脑膜破裂的实例。这些结果表明,这种内窥镜辅助技术既不会增加手术时间也不会损害疗效。相反,与传统方法相比,它导致荧光透视持续时间显着减少。
结论:人体尸体的解剖学研究,尸体的数量,和程序陡峭的学习曲线。
结论:在经皮脊柱内窥镜检查的协助下,在直接观察下,可以在预期的层间窗口位置刺穿黄韧带,提高穿刺的便利性,减少透视曝光。对于来自不同培训背景的外科医生来说,这是一个可行的替代方案,特别有利于那些精通内窥镜脊柱手术技术的人。
BACKGROUND: Spinal cord stimulation is an established technique wherein diverse electrode types are strategically implanted within the spinal epidural space for neuromodulation. Traditional percutaneous puncture cylindrical electrodes (PEs) are predominantly implanted by interventionalists utilizing a percutaneous technique under the monitor of radiation, which is a nonvisualized procedure.
OBJECTIVE: Our study aimed to assess the feasibility of percutaneous endoscope-assisted visualized implantation approach for PEs, delineating its specific merits and demerits compared to the traditional method.
METHODS: Laboratory study with Institutional Review Board Number B2023-056SETTING: Clinical Anatomy Research Center, Fudan University.
METHODS: Eight freshly procured adult cadavers (4 women and 4 men) were operated on in this study. They were divided into either Group A or Group B, each encompassing 4 cadavers. Group A was subjected to endoscope-assisted PEs implantation, whereas Group B followed the conventional PEs implantation route.In both groups the operative time of introducer needles placement (OTNP), total operative time (TOT), fluoroscopy time of introducer needles placement (FTNP), and total fluoroscopy time (TFT) were documented and analyzed. Furthermore, the precise positioning of the PEs and any ensuing complications were systematically examined.
RESULTS: Both Group A and Group B successfully executed all predetermined surgical steps. A total of 16 PEs were implanted (dual electrodes in each
cadaver): 8 using the percutaneous endoscope-assisted visualized approach (Group A) and 8 via the traditional methodology (Group B). Group A\'s mean ± SD durations for OTNP, TOT, FTNP, and TFT were 10.25 ± 1.03 minutes, 31.63 ± 5.87 minutes, 4.58 ± 1.35 seconds, and 43.73 ± 14.46 seconds, respectively. In contrast, Group B exhibited mean ± SD times of 11.55 ± 2.81 minutes, 44.75 ± 7.85 minutes, 23.53 ± 4.16 seconds, and 66.30 ± 6.35 seconds for the same metrics. No discernible statistical difference in OTNP and TOT emerged between the groups. However, Group A demonstrated reduced durations for both FTNP and TFT compared to Group B. The optimal position of the PEs was verified via fluoroscopy, with no recorded instances of dura rupture. These outcomes suggest that this endoscope-assisted technique neither increases surgical time nor compromises efficacy. Instead, it leads to a marked reduction in fluoroscopic duration relative to the traditional methodology.
CONCLUSIONS: Anatomical study on a human
cadaver, the quantity of cadavers, and the procedure\'s steep learning curve.
CONCLUSIONS: With the assistance of percutaneous spinal endoscopy, introducer needles can be punctured through the ligamentum flavum at the anticipated interlaminar window locus under direct visualization, improving the convenience of the puncture and reducing fluoroscopic exposure. It is a viable alternative for surgeons from diverse training backgrounds to implant PEs, particularly benefiting those well-versed in endoscopic spine surgery techniques.