可视环锯按需成形经皮椎间孔镜椎间盘切除术

Visual trephine on-demand target foraminoplasty in percutaneous endoscopic discectomy for migrated disc herniation

摘要:

目的：评价椎间孔镜可视环锯与不可视环锯靶向成形技术治疗腰椎腰椎间盘脱出症的安全性及有效性。 方法：纳入2019年3年至2021年7月因腰椎间盘脱出症在我科接受经Kambin三角椎间孔镜手术治疗的58例患者资料，按术前谈话结果，分为可视环锯组（后简称可视组）30例和不可视环锯组（后简称不可视组）28例，分析围术期、随访及影像数据。 结果：数据显示，可视组1例术后髓核残留，翻修后恢复可，不可视组1例出现术后神经根刺激症状，1例成形后骨碎块残留，余未见严重并发症，可视组患者术中X线照射次数、置管成功时间及出血量、术中VAS评分均低于不可视组（P＜0.05），术口长度、椎管减压时间、出院时间无差异（P＞0.05）。与术前相比，术后VAS、ODI评分均显著减低（P＜0.05），组间差异无显著性（P＞0.05），MacNad疗效评定组间差异无显著性（P＞0.05），复查影像资料，术后占位率显著减小（P＜0.05），椎间隙高度及腰椎前凸角未见明显变化，同一观察时点，组间差异不具显著性（P＞0.05）。 结论：靶向穿刺成形椎间孔镜手术治疗腰椎间盘脱出症临床疗效满意，可视环锯实现按需靶向成形，减少X线透视次数，缩短穿刺置管时间，减少穿刺成形出血量、减低患者术中疼痛感，提升患者术中体验等优势。

Abstract:

Objective:To explore the clinical safety and efficacy of visual trephine on-demand target foraminoplasty in percutaneous endoscopic discectomy for migrated disc herniation. Methods:To retrospective analyse data of 58 sufferers with migrated disc herniation underwent percutaneous transforaminal endoscopic discectomy from March 2019 to July 2021. 30 sufferers were treated with Visual trephine on-demand target foraminoplasty，28 sufferers underwent X-Ray monitoring foraminoplasty. Record perioperative data, 5-point Likert-type scale、VAS、ODI scores and modified MacNab standard was used to evaluate the clinical outcomes . Results：All sufferers had operation done，Visual trephine team was showed significantly superior to the control team as to the frequency of X-Ray monitoring、time of tube ascertained、blood loss、during-operation VAS scores and Likert-type scale (P<0.05). Visual trephine team was same to the control team as to incision length, decompress time and hospital stay between the two groups (P>0.05). The VAS scores and ODI score showed significantly less than preoperative (P<0.05), but there was no significant difference as to those scores at any corresponding time point, as well as excellent and good rate of clinical outcome valued by MacNab,s criteria at the latest follow-up between the two teams(P >0.05). Conclusion：Visual trephine on-demand target foraminoplasty showed advantages of less injuries、bleeding in percutaneous endoscopic discectomy for migrated disc herniation.