经皮脊柱内镜后外侧入路胸椎间盘切除术的可行性分析  

Feasibility Analysis of Posterolateral Approach Percutaneous Endoscopic Discectomy for Thoracic Disc Herniation

作　　者：李岳飞 李瑞[1] 王光林[1] 刘维克 窦永峰[1] 孙兆忠[1] Li Yuefei;Li Rui;Wang Guanglin(Department of Spinal Surgery,Binzhou Medical University Hospital,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院脊柱外科,滨州256600 [2]滨州市中医医院脊柱外科,滨州256600

出　　处：《中国微创外科杂志》2020年第10期950-954,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经皮脊柱内镜后外侧入路治疗胸椎间盘突出症(thoracic disc herniation,TDH)的疗效及可行性。方法2016年8月~2019年10月经皮脊柱内镜技术治疗9例TDH。定位患椎节段后建立软组织通道,扩大成形椎间孔。对软性椎间盘,内镜下直接摘除;对钙化性椎间盘,采用“涵洞减压”技术处理。采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)胸脊髓功能评分(11分法)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)及改良MacNab标准评估疗效。结果9例均顺利完成手术,无硬脊膜、胸神经损伤,术后CT、MR示胸椎管减压充分。随访6~25个月,平均15.4月,其中7例>12个月。术后1个月、末次随访时VAS、JOA、ODI较术前明显改善(P<0.05)。改良MacNab标准,优6例,良2例,可1例。结论经皮脊柱内镜后外侧入路治疗胸椎间盘突出症疗效确切,对钙化性突出椎间盘可采用“涵洞减压”技术去除。Objective To investigate the clinical efficacy and feasibility of the posterolateral approach percutaneous endoscopic discectomy in the treatment of thoracic disc herniation(TDH).Methods From August 2016 to October 2019,9 cases of TDH were treated by percutaneous endoscopic discectomy.During the operation,the affected vertebral segment was located,the soft tissue channel was established,and the intervertebral foramen was expanded and formed.The soft disc was removed under the endoscope,and the calcified disc was treated with the technique of“culvert decompression”.The Visual Analogue Scale(VAS),the Japanese Orthopedic Association(JOA)score,the Oswestry Disability Index(ODI)and the modified MacNab criteria were used to evaluate the efficacy.Results The operation was successfully completed in all the 9 patients without dural or thoracic nerve injury.Postoperative CT and MR showed that thoracic vertebral canal decompression was sufficient.The patients were followed up for 6-25 months,with an average of 15.4 months.The follow-up time of 7 patients was longer than 12 months.The VAS,JOA,and ODI were significantly improved 1 month after operation and at the last follow-up(P<0.05).The modified MacNab criteria showed 6 cases of excellent,2 cases of good and 1 case of fair.Conclusion The posterolateral approach endoscopic discectomy for the treatment of TDH is an effective and feasible minimally invasive operation in clinical practice.Calcified disc can be removed by“culvert decompression”technique.

关 键 词：胸椎间盘突出症 经皮脊柱内镜技术 后外侧入路 

分 类 号：R68[医药卫生—骨科学]