可视环锯技术治疗单侧神经根管狭窄症  

Foraminoplasty by using visible trephine technique in percutaneous transforaminal endoscopy for unilateral lumbar nerve root canal stenosis

作　　者：邹红军[1] 胡勇[1] 刘锦波[1] 吴俊[1] ZOU Hong-jun;HU Yong;LIU Jin-bo;WU Jun(Orthopedic Department,The Third People’s Hospital Affiliated with Suzhou University,Changzhou213003,China)

机构地区：[1]苏州大学附属第三人民医院骨科,江苏常州213003

出　　处：《中国矫形外科杂志》2021年第3期257-260,共4页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81972048);江苏省卫生健康委医学科研项目(编号:Z2019014);常州市卫生计生委青年人才科技项目(编号:QN201704);常州市卫生健康青苗人才培养工程资助(编号:CZQM2020046)。

摘　　要：[目的]介绍经皮椎间孔镜可视环锯减压治疗单侧神经根管狭窄症的手术技术与初步临床疗效。[方法]2017年10月~2019年11月采用经皮椎间孔镜可视环锯技术治疗腰椎管狭窄症患者32例。行椎间孔入路,将可视环锯置于椎间孔镜外侧,将工作套筒置于上关节突腹侧靠外固定,可视下左右旋转环锯,切除上关节突腹侧,通过髓核钳和等离子刀去除肥厚的黄韧带。[结果]32例患者均顺利手术,无严重并发症。随时间推移,患者腰痛VAS评分、腿痛VAS评分和ODI评分均显著下降(P<0.05)。末次随访时,依据改良的MacNab标准评估,临床结果优良率达90.6%。[结论]椎间孔镜下使用可视环锯技术能够在直视下安全高效地进行椎间孔扩大成形,有利于神经根在侧隐窝彻底减压及松解。[Objective]To introduce the surgical technique and preliminary clinical outcomes of foraminoplasty by using visible tre⁃phine technique in percutaneous transforaminal endoscopy for unilateral lumbar nerve root canal stenosis.[Methods]From October 2017 to December 2019,32 patients underwent aforesaid surgical intervention for unilateral lumbar nerve root canal stenosis.Through the transfo⁃raminal approach,a visible trephine was placed outside the intervertebral foramen,with working cannula placed and fixed on the ventral side of the upper facet process.Subsequently,the ventral part of upper facet process was removed under direct visualization with the turn⁃ing the trephine carefully to enlarge the intervertebral foramen.After that,the hypertrophic ligamentum flavum and osteophyte was removed with rongeur forceps and radiofrequency to release the nerve root completely.[Results]All the 32 patients had surgical procedures finished smoothly without serious complications.As time went,the VAS scores for low back pain and leg pain,as well as ODI score significantly de⁃creased(P<0.05).At the latest follow-up,the excellent and good rate of clinical outcomes was of 90.6%in term of the modified MacNab criteria.[Conclusion]This visible trephine technique does facilitate foraminoplasty in high safe and efficient way to decompress nerve root at nerve canal and lateral recess.

关 键 词：经皮椎间孔镜术 可视环锯 椎间孔成型 单侧神经根管狭窄症 

分 类 号：R687[医药卫生—骨科学]