椎间孔镜靶向穿刺新技术治疗腰椎间盘突出症

发布时间：2018-05-29 13:12

本文选题：椎间孔入路 + 靶向穿刺　；参考：《实用骨科杂志》2016年03期

【摘要】：目的探讨腰椎间盘突出靶向穿刺新技术减少经皮椎间孔全内镜腰椎间盘切除术(percutaneous transforaminal endoscopic lumbar discectomy,PTELD)的X线暴露和避免穿刺并发症的方法。方法运用我科自主研发的腰椎间盘突出靶点瞄准仪及靶向穿刺新方法,对46例腰椎间盘突出症患者实施PTELD手术,对术中的X线透视次数、靶向穿刺准确性、疼痛反应程度和术后的疼痛视觉类比评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、Mac Nab评估进行回顾性分析。结果靶向穿刺准确性:穿刺一次成功38例(82.6%),穿刺2次6例(13.1%),穿刺3次2例(4.3%)。局麻下置入套管疼痛反应:轻度37例(80.4%),中度8例(17.4%),重度1例(2.2%)。平均X线透视次数5.6次。无神经损伤、大血管损伤和硬膜囊撕裂并发症。术后平均随访10.6个月,术前术后VAS评分和ODI比较差异有统计学意义(P0.05),术后3个月进行Mac Nab疗效评定:优38例,良6例,可2例,差0例,优良率95.7%。结论腰椎间盘突出靶点瞄准仪引导靶向穿刺新技术能有效减少PTELD的X线暴露,降低手术风险,减轻疼痛反应,对PTELD初学者有很好的帮助。
[Abstract]:Objective to explore the method of reducing X-ray exposure and avoiding puncture complications of percutaneous endoscopic lumbar discectomy (transforaminal endoscopic lumbar) for lumbar disc herniation. Methods PTELD was performed on 46 patients with lumbar disc herniation by means of the target aiming instrument and the new method of targeted puncture, which was developed by our department. The X-ray fluoroscopy times and the accuracy of targeted puncture during the operation were analyzed. The degree of pain response and visual analogies of pain after operation were analyzed retrospectively. The visual analogue scale1 / VASA / Oswestry dysfunction index (Oswestry disability index) was used to evaluate Nab. Results the accuracy of targeted puncture: 38 cases were successfully punctured once, 6 cases were treated with 13.1 times, and 2 cases were treated with 4.3 times. The pain response of cannula placement under local anesthesia was as follows: mild 37 cases (80.4), moderate 8 cases (17.4%), severe 1 case (2.2%). The average number of X-ray fluoroscopy was 5.6 times. No nerve injury, major vascular injury and dural sac laceration complications. The average follow-up time was 10.6 months. The difference of VAS score and ODI was statistically significant (P 0.05). 3 months after operation, the curative effect of Mac Nab was evaluated: excellent 38 cases, good 6 cases, fair 2 cases, poor 0 cases, excellent and good rate 95.7%. Conclusion the new technique of target puncture guided by target aiming instrument for lumbar disc herniation can effectively reduce the X-ray exposure of PTELD, reduce the risk of operation and alleviate the pain reaction. It is helpful for the beginners of PTELD.
【作者单位】：深圳市龙岗中心医院骨科;
【基金】：深圳市知识创新计划项目(20150225094534)
【分类号】：R687.3

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