克氏针引导大直径环锯一次性椎间孔成形技术在椎间孔镜治疗腰椎间盘突出症中的应用  

Application of one-step foraminoplasty technology guided by Kirschner wire in large diameter trephine in transforaminal endoscopic discectomy for treatment of lumbar disc herniation

作　　者：朱小建[1] 徐冠华[2] 曹建华[1] 秦晓东 ZHU Xiaojian;XU Guanhua;CAO Jianhua;Qin Xiaodong(Department of Orthopedics,the Forth People′s Hospital of Nantong,Jiangsu Province,Nantong 226005;Department of Orthopedics,the First People′s Hospital of Nantong,Jiangsu Province)

机构地区：[1]江苏省南通市第四人民医院骨科,南通226005 [2]江苏省南通市第一人民医院骨科

出　　处：《南通大学学报（医学版）》2018年第4期270-274,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市科技局指令性课题(MS22016005;MS32016022);江苏省"科教强卫工程"青年医学人才资助项目(QNRC2016403)

摘　　要：目的:观察克氏针引导大直径环锯一次性椎间孔成形技术在椎间孔镜治疗腰椎间盘突出症中的应用效果。方法:选择62例椎间盘突出症患者,随机分为观察组32例和对照组30例,对照组采用Joimax公司常规绿色、黄色和红色环锯依次扩大椎间孔,观察组椎间孔成形采用克氏针引导直径8.5 mm环锯一次性成形技术。比较两组椎间孔成形时间、成形过程中透视次数、手术总时间、手术前后视觉模拟评分(visual analogue scale, VAS)和术后疗效。结果:观察组术中椎间孔成形时间、成形过程透视次数、手术总时间均显著少于对照组(P<0.05)。两组术后VAS评分均显著低于术前,两组间术后VAS评分差异无统计学意义(P>0.05)。观察组术后优良率(96.9%)与对照组(96.7%)比较差异无统计学意义(P>0.05)。观察组中出现一过性L4出口神经根损伤1例,对照组出现椎间隙感染1例,两组均未出现硬脊膜破裂、大血管损伤。结论:克氏针引导大直径环锯一次性椎间孔成形的技术在椎间孔镜手术中取得良好效果,能够明显减少椎间孔成形的操作步骤、椎间孔成形时间及X线暴露次数,缩短手术时间。Objective:To observe the application effect in transforaminal endoscopic discectomy for treatment of lumbar disc herniation using the one-time foraminoplasty technology of K-wire guiding large diameter trephine.Methods:62 patients with lumbar disc herniation were randomly divided into observation group(32 cases)and control group(30 cases),in the control group conventional green,yellow and red trephines(Joimax)were used to expand the intervertebral foramen,the observation group foraminoplasty application of K-wire positioning with large diameter trephine forming technology.The forming time of the intervertebral foramen,the times of fluoroscopy and the total time of operation,visual analogue scale(VAS)and postoperative effect were compared between the two groups.Results:The time of forming the intervertebral foramen,the forming process,the fluoroscopy times and the total operation time in the observation group were significantly less than those in the control group(P<0.05).The VAS scores of the two groups were significantly lower than those before the operation.The difference of VAS score after operation between the two groups was not statistically significant(P>0.05).The excellent and good rate of the observation group(86.89%)was no significant difference compared with the control group(83.05%)(P>0.05).One case of transient lumbar 4 exit nerve root injury was observed in the observation group,one case of infection of intervertebral space occurred in the control group,there were no dural rupture and major vascular injuries in the two groups.Conclusion:K-wire guide large diameter trephine foraminoplasty technology has good effect in the clinical application of percutaneous transforaminal endoscopic discectomy.This method achieves good results,significantly reduces foraminoplasty steps and the time of forming the intervertebral foramen,shortens the duration of surgery,and decreases the frequency of X-ray exposure.

关 键 词：腰椎间盘突出症 椎间孔成形 脊柱内镜 髓核摘除术 

分 类 号：R683.2[医药卫生—骨科学]