克氏针锚定同心引导工作套管直接椎间孔成形技术在腰椎间盘突出症治疗中的应用  

Clinical application of direct intervertebral foraminoplasty technique with Kirschner wire anchor concentric guide sleeve in the treatment of lumbar disc herniation

作　　者：崔西龙[1] 于海洋[1] 梁成民[1] 翟云雷[1] 焦伟[1] CUI Xi-long;YU Hai-yang;LIANG Cheng-min;ZHAI Yun-lei;JIAO Wei(Department of Orthopaedics,Fuyang People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市人民医院骨科,安徽省脊柱畸形临床医学研究中心,安徽阜阳236000

出　　处：《颈腰痛杂志》2023年第2期183-185,共3页The Journal of Cervicodynia and Lumbodynia

基　　金：安徽省科技厅2017年重点研究与开发计划立项项目(编号:1704a0802159);阜阳市自筹经费科技计划项目(编号:FK202081022)。

摘　　要：目的观察克氏针同心引导工作套管直接椎间孔成形技术在椎间孔镜治疗腰椎间盘突出症中的临床效果。方法选取2019年5月~10月收治的腰椎间盘突出症患者24例,男18例,女6例;年龄23~71岁,平均(48.7±13.9)岁;L 4-5突出20例,L 5-S 14例。患者均行椎间孔镜下髓核摘除神经根减压术,术中采用克氏针锚定同心引导工作套管直接椎间孔成形技术,分析其手术情况和临床疗效。结果①手术情况:椎间孔成形时间5~7 min,平均5.7 min;手术总时间60~80 min,平均72.3 min;椎间孔成形过程中的VAS评分4~6分,平均5.1分;术中透视5~6次,平均5.4次;无感染、神经损伤、硬膜撕裂等并发症。②疗效:所有患者均获随访18~23个月,平均16.8个月。与术前相比,患者术后、术后3个月及末次随访时的腰腿痛VAS评分和JOA评分、ODI指数均获显著改善,差异有统计学意义(P<0.05)。末次随访按MacNab标准评价疗效,优19例,良4例,可1例,优良率为95.8%。结论克氏针锚定同心引导工作套管直接椎间孔成形技术能减少椎间孔成形时间、术中X线暴露次数,减轻成形过程中的疼痛,是椎间孔成形的安全有效治疗方法。Objective To observe the clinical effect of direct intervertebral foraminoplasty technology with Kirschner wire concentric guide working sleeve in the treatment of lumbar disc herniation by foramen endoscopy.Methods From May 2019 to October 2019,24 patients with lumbar disc herniation were selected,including 18 males and 6 females,aged 23-71 years,with an average of(48.7±13.9)years,among whom 20 cases had L 4-5 lumbar disc herniation,and 4 cases had L 5-S 1 lumbar disc herniation.The nerve root decompression was performed by the removal of nucleus pulposus under foramen endoscopy.The direct intervertebral foraminoplasty with Kirschner wire anchor concentric guide sleeve was adopted during the operation.The surgical situation and clinical efficacy were analyzed.Results①Surgical conditions:the time for foraminoplasty was 5-7 min,with an average of 5.7 min;the total operation time was 60-80 min,with an average of 72.3 min;the VAS score during foraminoplasty was 4-6 points,with an average of 5.1 points.Fluoroscopy was performed 5-6 times,with an average of 5.4 times;no complications such as infection,nerve injury and dura mater tear were found.②Curative effect:all patients were followed up for 18-23 months,with an average of 16.8 months.Compared with before operation,the VAS score,JOA score and ODI index of low back and leg pain in patients after operation,3 months after operation,and at the last follow-up were all significantly improved,and the differences were statistically significant(P<0.05).According to the MacNab standard at last follow-up,19 cases were excellent,4 cases were good,and 1 case was fair,with an excellent and good rate of 95.8%.Conclusion The direct intervertebral foraminoplasty technique with Kirschner wire anchor concentric guide sleeve can reduce the operation time of intervertebral foramen forming and the number of X-ray exposure during operation,and reduce the pain.It is a safe and effective treatment for foraminoplasty.

关 键 词：克氏针锚定 同心引导工作套管 直接椎间孔成形技术 椎间孔镜 腰椎间盘突出症 

分 类 号：R681.53[医药卫生—骨科学] R687.3[医药卫生—外科学]