单侧双通道内镜钥匙孔技术治疗旁中央颈椎间盘突出△

Unilateral biportal endoscopy with keyhole technique for paracentral cervical disc herniation

摘要:

[目的] 介绍单侧双通道内镜 （unilateral biportal endoscopy, UBE） 钥匙孔技术治疗旁中央颈椎间盘突出的手术技术和初步临床效果。[方法]对 1 例旁中央颈椎间盘突出患者行上述治疗。依据术前影像确定手术入路和工作通道位置，将工作通道分别置于右侧 C₅ 椎板下缘上下两侧，下方通道置入内窥镜，上方通道置入手术器械，磨薄边缘椎板，切除部分软组织和黄韧带，充分显露责任神经根，剥离粘连组织后使用髓核钳取出突出髓核组织。[结果]本例患者顺利完成手术，术后症状显著缓解，次日可下床活动，随访 1 年，术前颈肩部 VAS 评分 5 分，上肢 VAS 评分 7 分，末次随访时均为 2 分。NDI 评分术前 26.7%，末次随访时为 6%。未发现远期手术并发症及症状复发。[结论]UBE 下钥匙孔技术可以在达到微创目的的同时，明显改善旁中央颈椎间盘突出患者的临床症状。

Abstract:

[Objective] To present the surgical technique and preliminary clinical results of unilateral biportal endoscopy (UBE) with keyhole technique for paracentral cervical disc herniation. [Methods] A patient with paracentral cervical disc herniation underwent the above treatment. The positions of the surgical portals were determined according to the preoperative images, then the working channel tube was placed onto the upper and lower sides of the lower margin of the right C₅ lamina, while the endoscope was placed in the lower portal. As surgical instruments were used in the working channel, the marginal lamina was ground thin, part of the soft tissue and the yellow ligament were removed until the responsible nerve root was fully exposed. After the adhesive tissue was removed, the protruded disc was resected by using nucleus pulposus forceps. [Results] The patient was operated on successfully, had symptoms significantly relieved postoperatively, and could get out of bed the next day. Followup period lasted for 1 year, the VAS score significantly decreased from neck and shoulder score of 5 and upper limb of 7 preoperatively to both of 2 at the latest follow-up. The NDI score significantly declined from 26.7% before surgery to 6% at the last follow-up. No long-term complications and recurrent symptoms were found. [Conclusion] Keyhole technique under UBE does significantly improve the clinical symptoms of patients with paracentral cervical disc herniation while achieving minimally invasive purpose.