侧路孔镜靶点穿刺置管治疗重度脱垂型腰椎间盘突出症  

Treatment of highly migrated lumbar disc herniation by lateral approach with targeted puncture technique

作　　者：陈兴银 刘莹 叶正云 吴小松 洪琦 柳维 娄盼 倪鹏辉 李武 CHEN Xing-yin;LIU Ying;YE Zheng-yun;WU Xiao-song;HONG Qi;LIU Wei;LOU Pan;NI Peng-hui;LI Wu(Department of Spine Surgery,Jingmen Central Hospital,Jingmen,Hubei 448000,China;Department of Gastroenterology,Jingmen Central Hospital,Jingmen Hubei 448000,China)

机构地区：[1]荆门市中心医院脊柱外科,湖北荆门448000 [2]荆门市中心医院消化内科,湖北荆门448000

出　　处：《颈腰痛杂志》2023年第6期1004-1006,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨经皮侧路孔镜下靶点穿刺置管治疗重度脱垂型腰椎间盘突出症(highly migrated lumbar disc herniation,HMLDH)的可行性。方法2015年5月~2019年12月,我院收治HMLDH 38例,其中向上重度脱垂型10例,向下重度脱垂型28例;突出节段L 3-46例,L 4-532例。采用经皮侧路椎间孔镜下靶点穿刺置管,直视下摘除脱垂的髓核。结果手术时间45~180 min、平均90 min,无手术相关并发症。38例随访12~42个月,术前1 d、术后1 d和末次随访时的腰腿痛VAS分别为(7.6±2.1)分、(1.5±1.3)分、(1.4±0.8)分,ODI指数分别为(20.2±7.5)%、(9.5±4.0)%、(6.3±2.4)%。根据MacNab标准,术后第1天优33例、良5例;最后一次随访时,优36例、良2例。结论经皮侧路孔镜下靶点穿刺技术治疗HMLDH是一种安全、有效、可行的手术方法。Objective To investigate the feasibility of highly migrated lumbar disc herniation(HMLDH)migrated by lateral approach with targeted puncture technique.Methods From May 2015 to December 2019,38 cases of HMLDH were treated in Jingmen First People’s Hospital,including 10 cases of severe upward disc herniations and 28 cases of sever down-migrated disc herniations.There were 6 cases of L 3-4 disc herniation,32 cases of L 4-5.During the surgery,the prolapsed nucleus pulposus was removed under direct vision by lateral approach with targeted puncture technique.Results The surgical time was 45-180 minutes,with an average of 90 minutes,and there were no surgical related complications.Altogether 38 cases were followed up for 12-42 months.The VAS score of low back and leg pain was(7.6±2.1)points,(1.5±1.3)points,and(1.4±0.8)points on the day before surgery,1 day after surgery,and at the last follow-up,respectively.The ODI index was(20.2±7.5)%,(9.5±4.0)%,and(6.3±2.4)%,respectively.According to MacNab standard,there were 33 excellent cases and 5 good cases on the first day after surgery,36 excellent cases and 2 good cases at the last follow-up.Conclusion Percutaneous endoscopic target puncture is a safe,effective and feasible surgical method for HMLDH.

关 键 词：椎间孔镜 靶点穿刺置管 重度脱垂 腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]