经椎间孔入路经皮内窥镜下椎间盘切除术中应用可视化骨凿切除部分椎弓根上缘治疗极高度游离型腰椎椎间盘突出症  

Treatment of extremely highly migrated lumbar disc herniation with visualization superapedicular opening technique in percutaneous endoscopic transforaminal discectomy

作　　者：李道友 滕红林[1] 林超伟[1] 朱旻宇[1] LI Dao-you;TENG Hong-lin;LIN Chao-wei;ZHU Min-yu(Department of Spinal Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院脊柱外科,温州325000

出　　处：《脊柱外科杂志》2020年第5期310-314,共5页Journal of Spinal Surgery

摘　　要：目的评估经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)中应用可视化骨凿切除部分椎弓根上缘治疗极高度游离型腰椎椎间盘突出症(LDH)的疗效。方法2017年1月—2018年6月,采用PETD治疗极高度游离型LDH患者16例,术中应用可视化骨凿直视下切除部分椎弓根上缘以增加套管工作距离。采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及改良MacNab标准评估手术疗效。术后复查MRI,以明确是否存在髓核残留,通过动力位X线片观察是否发生节段性不稳。结果所有手术顺利完成,手术时间(54.2±10.7)min,术后所有患者随访(13.5±4.6)个月。术后1 d腰痛VAS评分、下肢痛VAS评分及ODI均较术前明显改善,且术后3个月较术后1 d改善更为明显,差异均有统计学意义(P<0.05)。改良MacNab标准评定的术后1年疗效:优9例,良5例,可2例。所有患者术后无髓核残留、节段性不稳发生。结论PETD术中应用可视化骨凿切除部分椎弓根上缘治疗极高度游离型LDH安全、有效,且髓核摘除彻底,功能恢复满意。Objective To investigate the feasibility and efficacy of percutaneous endoscopic transforaminal discectomy(PETD)with visualization superapedicular opening technique for the treatment of extremely highly migrated lumbar disc herniation(LDH).Methods From January 2017 to June 2018,16 patients with extremely highly migrated LDH were treated with PETD.During the operation,part of the upper edge of the pedicle was removed by visualization superapedicular opening technique to increase the working distance of the sleeve.The visual analogue scale(VAS)score,Oswestry disability index(ODI)and modified MacNab criteria were used to evaluate the outcome of surgery.Postoperative MRI was performed to confirm whether there was residual nucleus pulposus and dynamic roentgenographs to observe whether there was segmental instability.Results All the operations were successfully completed.The operation time was(54.2±10.7)min.All the patients were followed up for(13.5±4.6)months.The low back pain and leg pain VAS scores and ODI were improved at postoperative 1 d,3 months,in addition,the above indexes at postoperative 3 months were significantly improved compared with those at postoperative 1 d,all with a statistical significance(P<0.05).According to modified MacNab criteria,excellent outcome was achieved in 9 cases,good in 5 and fair in 2.Neither residual nucleus pulposus nor segmental instability were observed in all the patients.Conclusion It is safe and effective to remove part of the upper edge of the pedicle by visualization superapedicular opening technique in PETD for the treatment of extremely highly migrated LDH,and the nucleus pulposus can be completely removed with satisfactory functional recovery.

关 键 词：腰椎 椎间盘移位 内窥镜检查 减压术 外科 外科手术 微创性 

分 类 号：R681.553.1[医药卫生—骨科学]