椎间孔镜靶向穿刺新技术治疗腰椎间盘突出症  

A New Targeted Puncture Technique for Percutaneous Transforaminal Endoscopic Lumbar Discectomy in Treatment of Lumbar Disc Herniation

作　　者：曾月东[1] 苏建成[1] 谢伟[1] 谭平先[1] 包杰[1] 

机构地区：[1]深圳市龙岗中心医院骨科,广东深圳518116

出　　处：《实用骨科杂志》2016年第3期201-204,241,共5页Journal of Practical Orthopaedics

基　　金：深圳市知识创新计划项目(20150225094534)

摘　　要：目的探讨腰椎间盘突出靶向穿刺新技术减少经皮椎间孔全内镜腰椎间盘切除术(percutaneous transforaminal endoscopic lumbar discectomy,PTELD)的X线暴露和避免穿刺并发症的方法。方法运用我科自主研发的腰椎间盘突出靶点瞄准仪及靶向穿刺新方法,对46例腰椎间盘突出症患者实施PTELD手术,对术中的X线透视次数、靶向穿刺准确性、疼痛反应程度和术后的疼痛视觉类比评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、Mac Nab评估进行回顾性分析。结果靶向穿刺准确性:穿刺一次成功38例(82.6%),穿刺2次6例(13.1%),穿刺3次2例(4.3%)。局麻下置入套管疼痛反应:轻度37例(80.4%),中度8例(17.4%),重度1例(2.2%)。平均X线透视次数5.6次。无神经损伤、大血管损伤和硬膜囊撕裂并发症。术后平均随访10.6个月,术前术后VAS评分和ODI比较差异有统计学意义(P<0.05),术后3个月进行Mac Nab疗效评定:优38例,良6例,可2例,差0例,优良率95.7%。结论腰椎间盘突出靶点瞄准仪引导靶向穿刺新技术能有效减少PTELD的X线暴露,降低手术风险,减轻疼痛反应,对PTELD初学者有很好的帮助。Objective To explore the methods to reduce X-ray exposure and avoid targeted puncture complications in percutaneous transforaminal endoscopic lumbar discectomy （PTELD）. Methods 46 patients with lumbar disc herniation were subjected to PTELD using a new targeted puncture technique with application of a lumbar disc herniation target guiding apparatus. The times of X-ray fluoroscopy, the targeted puncture accuracy, the degree of pain response during surgery, and visual analogue scale（VAS） ,Oswestry disability index （ODI） ,Macnab postoperatively were reviewed. Results 38 cases in success of first puncture （ 8 2. 6 % ） , 6 cases in success of puncture two times （ 1 3. 1% ） , 2 cases in success of puncture three times （4.3%）. As for pain response under local anesthesia,outcomes were mild 37 cases （80.4%）, moderate 8 cases （ 17.4% ） and severe 1 care （2.2%）. The average number of times of X-ray fluoroscopy was 5.6 times. No nerve injury ,large blood vessel injury, dural laceratione and infection was observed. Average follow-up 10.6 months, VAS and ODI scores preoperatively and postoperatively had statistically significant difference （ P 〈 0.05 ）. According to Macnab criteria, the surgical outcomes were excellent in 38 cases, good in 6 cases,fair in 2 cases, poor in 0 case, with the excellent-to-good rate of 95.7%. Conclusion The new targeted puncture technique can significantly reduce X-ray exposure in PTELD, as well as the surgical risk and patient＇s pain response, this new puncture technique will greatly help new learners of PTELD.

关 键 词：椎间孔入路 靶向穿刺 穿刺引导仪 X线暴露 腰椎间盘切除术 

分 类 号：R681.53[医药卫生—骨科学]