硬膜外运动-感觉分离麻醉在经椎间孔入路经皮内窥镜下椎间盘切除术中的应用  

Application of epidural motor-sensory separation analgesia in percutaneous endoscopic transforaminal discectomy

作　　者：杨德育 熊华平 郑耿阳 尤瑞金 Yang Deyu;Xiong Huaping;Zheng Gengyang;You Ruijin(Department of Orthopaedics,No.910 Hospital of Joint Logistics Support Force of Chinese PLA,Quanzhou 362000,Fujian,China;Department of Anesthesiology,No.910 Hospital of Joint Logistics Support Force of Chinese PLA,Quanzhou 362000,Fujian,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院骨科,泉州362000 [2]中国人民解放军联勤保障部队第910医院麻醉科,泉州362000

出　　处：《脊柱外科杂志》2023年第4期259-262,共4页Journal of Spinal Surgery

摘　　要：目的探讨硬膜外运动-感觉分离麻醉在经椎间孔入路经皮内窥镜下椎间盘切除术中(PETD)的应用效果。方法2017年10月—2020年1月,采用PETD治疗腰椎椎间盘突出症(LDH)患者137例,其中77例术中采用硬膜外运动-感觉分离麻醉(分离组),60例采用局部麻醉(局部组)。记录2组患者手术时间、透视次数及并发症发生情况。术前、术后3个月采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,并分别记录切开皮肤时、椎间孔成形时及处理后纵韧带时的VAS评分;采用日本骨科学会(JOA)评分评估腰椎功能。术后3个月随访时统计患者再手术意愿。结果所有手术顺利完成。分离组随访12~25(17.33±6.12)个月,局部组随访12~27(18.56±6.11)个月。分离组手术时间短于局部组,再手术意愿优于局部组,差异均有统计学意义(P<0.05);2组透视次数差异无统计学意义(P>0.05)。2组术后3个月VAS评分、JOA评分较术前明显改善,差异均有统计学意义(P<0.05);组间差异无统计学意义(P>0.05)。分离组在椎间孔成形时、处理后纵韧带时的VAS评分优于局部组,差异均有统计学意义(P<0.05);2组切开皮肤时的VAS评分差异无统计学意义(P>0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论硬膜外运动-感觉分离麻醉用于PETD具有患者接受程度高、麻醉效果好等优点,可以有效降低术中疼痛,利于手术顺利完成。Objective To explore the effect of epidural motor-sensory separation anesthesia in percutaneous endoscopic transforaminal discectomy(PETD).Methods From October 2017 to January 2020,137 patients with lumbar disc herniation(LDH)were treated with PETD,of which 77 were treated with epidural motion-sensory separation anesthesia(separation group)and 60 with local anesthesia(local group).Operation time,fluoroscopy frequency and complications were recorded in 2 groups.Visual analog scale(VAS)score was used to evaluate pain intensity before operation and 3 months after operation;and VAS scores were recorded during skin incision,foraminoplasty and posterior longitudinal ligament treatment,respectively.Lumbar function was evaluated by the Japanese Orthopaedic Society(JOA)score.The intention of reoperation was recorded at postoperative 3 months.Results All the operations were successfully completed.The separation group was followed up for 12-25(17.33±6.12)months,and the local group for 12-27(18.56±6.11)months.The operation time of the separation group was shorter than that of the local group,and the intention of reoperation was better than that of the local group,and the differences were statistically significant(P<0.05).There was no significant difference in fluoroscopy frequency between the 2 groups(P>0.05).VAS score and JOA score of the 2 groups were significantly improved at postoperative 3 months,all with a statistical significance(P<0.05);there was no significant difference between the 2 groups(P>0.05).The VAS scores at foraminoplasty and posterior longitudinal ligament treatment of the separation group was better than those of the local group,and the differences were statistically significant(P<0.05);there was no significant difference in VAS score during skin incision between the 2 groups(P>0.05).There was no significant difference in the incidence of complications between the 2 groups(P>0.05).Conclusion The application of epidural motor-sensory separation anesthesia in PETD has the advantages of high acceptance of

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 经皮 外科手术 微创性 麻醉 局部 镇痛 

分 类 号：R681.533.1[医药卫生—骨科学]