椎间盘镜辅助脊髓刺激电极植入治愈下肢缺血1例  

Lower limb ischemia cured by stimulation electrode implantation assisted with microendoscopic discectomy system:A case report

作　　者：钱亚龙[1] 徐帅[1] 刘海鹰[1] QIAN Ya-long;XU Shuai;LIU Hai-ying(Department of Spinal Surgery, Peking University People’s Hospital, Beijing 100044, China)

机构地区：[1]北京大学人民医院脊柱外科,北京100044

出　　处：《北京大学学报（医学版）》2020年第2期378-381,共4页Journal of Peking University:Health Sciences

摘　　要：椎间盘镜下椎间盘摘除术(microendoscopic discectomy,MED)是脊柱外科目前比较成熟的微创手术,该技术通过经皮小切口置入通道,利用光源和影像采集放大系统提供清晰的手术视野[1]。脊髓电刺激(spinal cord stimulation,SCS)治疗是将脊髓刺激器的电极置于硬膜外腔,通过不同的电流脉冲刺激脊髓不同部位,实现调节神经功能以及疼痛治疗。对于不适合开放手术或血管介入的慢性肢体缺血疼痛患者,脊髓电刺激治疗也是非常合适的选择[2-3]。传统的刺激电极植入方法是在透视下经皮用导针直接植入,并发症发生率高,容易造成硬膜损伤或硬膜外血肿,并且电极位置调整困难,透视次数较多,植入多个电极时难度极大[4];如果通过内镜辅助在直视下植入电极将有助于改善上述缺点,椎间盘镜辅助脊髓刺激电极植入技术国内未见报道,北京大学人民医院成功实施1例椎间盘镜辅助下脊髓刺激电极植入治疗下肢缺血的病例,现报道如下。A 58-year-old male patient diagnosed with thromboangiitis obliterans(Fontaine stageⅣ)was recently treated with microendoscope discectomy system-assisted spinal cord stimulation electrode implantation and cured by department of vascular surgery combined with department of spinal surgery at Peking University People’s Hospital.The patient suffered from cold injury to the right foot 14 years ago,which was cold,painful,numb,and then the toe was ulcerated and gangrene.Only the right foot small toe was left.The right foot skin was swollen from the toe to the proximal segment 1 year ago,accompanied by resting pain.Both pain and autologous bone marrow stem cell transplantation were ineffective.The above symptoms were aggravated three months ago,and the pain was severe.The visual analogue score was 10 points.A high amputation of the left lower extremity was performed 30 years ago due to trauma.Physical examination:the bilateral femoral artery was weak,and the right radial artery,posterior tibial artery,and dorsal artery were not touched.Buerger sign(+).Auxiliary examination:angiography of both lower extremities showed complete occlusion of the bilateral external iliac artery and its distal end.The percutaneous oxygen partial pressure was measured to be 30 mmHg on the right side of the iliac crest.The operation was performed under the local anesthesia.After X-ray positioning,the body projection of the lumbar vertebrae 1-2 lamina gap was marked.The skin had a 1.8 cm incision on the caudal side 2 cm from the mark.Then the dilators were used,and the working sleeve was tilted to the lumbar vertebrae 1-2 lamina gap.The microendoscope discectomy system was installed,the electrode was directly placed into the epidural space from the interlamina space under the microendoscope,the vascular surgeon adjusted the position of the electrode in the spinal canal under fluoroscopy,then connected the stimulator,adjusted the current until the patient had the lower limb fever,fixed electrode position,removed the microendoscope discectomy s

关 键 词：椎间盘镜 脊髓电刺激 血栓闭塞性脉管炎 

分 类 号：R682.6[医药卫生—骨科学]