经椎间孔入路经皮内窥镜下椎间盘切除术改良胸膝卧位与常规俯卧位对L_5/S_1椎间孔高度及穿刺时间的影响  

Influence of modified knee-chest and prone position on foraminal height and operation time in L_5/S_1 percutaneous endoscopic transforaminal discectomy

作　　者：任大江[1] 杜培[1] 张思萌[1] 文天林[1] 张志成[1] 李放[1] 

机构地区：[1]北京军区总医院骨科,北京100700

出　　处：《脊柱外科杂志》2015年第6期356-359,共4页Journal of Spinal Surgery

摘　　要：目的探讨经椎间孔入路经皮内窥镜下椎间盘切除术（percutaneous endoscopic transforaminal discectomy,PETD）中不同体位下L_5/S_1椎间孔的高度变化及手术穿刺时间。方法回顾性分析2014年5月-2015年5月采用改良胸膝卧位及2013年6月-2014年4月采用常规俯卧位行PETD治疗的L_5/S_1椎间突出患者资料各30例。记录不同体位下穿刺时间,术中、术后并发症;测量椎间孔高度;计算椎间孔开大率。结果所有患者均在局部麻醉下顺利完成手术。常规俯卧位患者出现术后感觉迟钝1例。2种体位穿刺时间、椎间孔高度比较,改良胸膝卧位穿刺时间更短、椎间孔高度更大。改良胸膝卧位椎间孔平均开大率为57.0%。结论 L_5/S_1节段行PETD常规采用改良胸膝卧位,可显著增加椎间孔高度,降低穿刺放置通道的难度并降低出口根损伤概率,同时可以提高患者体位耐受性并减少术中镜下出血。Objective To explore the effect on change of L5/ S1 foramen height and operation time in different intraoperative positions when percutaneous endoscopic transforaminal discectomy（ PETD） was performed. Methods A total of 30 patients from May 2014 to May 2015 who underwent PETD in modified knee-chest position and 30 patients from June2013 to April 2014 who underwent PETD in prone position were analyzed,retrospectively. The operation time,foramen height and intra-and postoperative complications were recorded and analyzed. The mean enlargement rate of foramen was caleulated.Results All the cases went through the surgery successfully under local anesthesia. Postoperative dysesthesia occurred in 1case in prone position. There was significant difference in terms of operation time and foramen height（ P〈0. 05）. Operation time was shorter,and L5/ S1 foramen height was larger in modified knee-chest position,with mean enlargement rate of57. 0%. Conclusion There are more advantages in L5/ S1 PETD of using modified knee-chest position than using prone position,especially in the enlargement of L5/ S1 foramen,which has less difficulty in putting the canula.

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 经皮 外科手术 微创性 

分 类 号：R681.53[医药卫生—骨科学]