经椎间孔入路全内镜下胸椎间盘摘除术的技术要点及疗效分析  

Technical notes and clinical efficacy analysis of full-endoscopic thoracic discectomy via transforaminal approach

作　　者：李振宙[1] 赵宏亮 曹峥[1] 商卫林[1] 侯树勋[1] Li Zhenzhou;Zhao Hongliang;Cao Zheng;Shang Weilin;Hou Shuxun(Department of Orthopaedics,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心骨科,北京100048

出　　处：《中华医学杂志》2020年第4期279-285,共7页National Medical Journal of China

摘　　要：目的研究经椎间孔入路全内镜下胸椎间盘摘除术的技术要点及临床疗效。方法纳入2017年1月至2018年9月解放军总医院第四医学中心骨科采用经椎间孔入路全内镜下胸椎间盘摘除术治疗的16例胸椎间盘突出症患者。平均年龄53.7岁。致压物按性质分类包括软性胸椎间盘突出5例、钙化或骨化型胸椎间盘突出7例、病变椎间盘相邻椎体后缘骨赘型突出4例。术前所有患者均表现胸脊髓病症状,其中7例合并神经根性症状。采用局部麻醉下经椎间孔入路、椎间孔扩大成型及全内镜下胸椎间盘摘除术治疗。观察术后影像学的变化,术后1周、3个月、6个月及术后1年时疼痛症状及脊髓功能恢复状况。背痛及神经根性疼痛采用视觉模拟评分(VAS)评分,神经学功能评估采用Nurick评分及改良日本骨科学会(mJOA)评分,胸椎功能评价采用Oswestry功能障碍指数(ODI)。结果所有手术均顺利完成,无术中更换手术方式发生。所有患者术后胸椎MRI及CT检查均显示脊髓减压充分,无致压物残留。所有患者术后背痛、神经根性疼痛均明显缓解,脊髓功能明显恢复,术后1年mJOA恢复率为50%~87.5%,平均72.0%。有2例术后出现一过性肋间神经痛,无其他手术并发症发生。结论局部麻醉下经椎间孔入路全内镜下椎间孔扩大成型、全内镜下胸椎间盘摘除术是治疗位于脊髓腹侧的软性及硬性胸椎间盘突出症的安全、有效的微创脊柱外科技术。Objective To study the technical notes and clinical efficacy of full-endoscopic thoracic intervertebral discectomy via transforaminal approach.Methods We included 16 patients with thoracic disc herniation treated by full-endoscopic thoracic discectomy via transforaminal approach between January 2017 and September 2018 in ours department of orthopedics.The average age is 53.7 years.The compressionare classified by nature:5 cases of soft thoracic disc herniation,7 cases of calcified or ossified thoracic disc herniation,and 4 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc.All patients had symptoms of thoracic myelopathy before operation,and 7 of them had radiculopathy.Via transforaminal approach under local anesthesia,enlarged foraminoplasty and full-endoscopic thoracic discectomy were used for treatment.Observe the changes of postoperative imaging,pain symptoms and recovery of spinal cord function at 1 week,3 months,6 months and 1 year after operation.Back pain and radicular pain were scored with VAS,neurological function was assessed with Nurick score and mJOA score,and thoracic spine function was assessed with Oswestry disability index(ODI).Results All operations were successfully completed,and no intraoperative conversion of surgical methods occurred.Postoperative thoracic MRI and CT examinations of all patients showed that the spinal cord was fully decompressed without any residual compression.Back pain and radicular pain were all relieved obviously in all patients,and spinal cord function was obviously restored.Transient intercostal neuralgia occurred in 2 cases after operation,and no other surgical complications occurred.Conclusions Full-endoscopic or fluoroscopic foraminoplasty and full-endoscopic thoracic discectomyvia transforaminal approach under local anesthesia is a safe and effective treatment for soft and hard thoracic disc herniation located on the ventral side of the spinal cord.

关 键 词：胸椎间盘突出症 全内镜 胸椎间盘摘除术 经椎间孔入路 椎间孔成型术 

分 类 号：R687[医药卫生—骨科学]