摘要
目的介绍椎间孔镜BEIS技术穿刺定位、通道建立及减压方法的核心理论,并结合临床病例评价其疗效。方法采用标准化穿刺定位建立的BEIS通道和模式化的镜下减压方法对278例诊断为腰椎间盘突出症或腰椎管狭窄症或腰椎间盘突出伴椎管狭窄症的患者行手术治疗,分别记录术前、出院时、术后3个月、术后6个月、术后1年和末次随访的疼痛视觉模拟评分法(VAS)和日本骨科协会治疗评分(JOA),评价疗效。结果278例患者共行BEIS手术295次,269次(91.2%)穿刺定位进针点无需调整,26次(8.8%)需调整进针点重新穿刺。穿刺时间平均20.6 min。出院后所有患者均得到随访,随访时间均达到1年及以上。术后患者的VAS评分逐渐降低,末次评分与术前相比较差异有统计学意义(P<0.05)。术后患者的JOA评分逐渐升高,末次评分与术前相比较差异有统计学意义(P<0.05)。根据JOA改善率,末次随访优良率86.3%,有效率达96.4%。结论标准化、模式化的BEIS技术具有更广阔的镜下操作空间,扩大了椎间孔镜技术的适应证范围,临床疗效为满意,值得进一步推广。
Objective To introduce the core theory of the BEIS technique for the method of puncture,endoscopic channel establishment and decompression,and evaluate the curative effect with clinical cases.Methods A total of 278 patients diagnosed as lumbar disc herniation or lumbar spinal stenosis or lumbar disc herniation with spinal stenosis were treated with standardized and patterned BEIS technique.The VAS and JOA scores were recorded respectively before operation,and at discharge,3 months,6 months,1 year and last follow-up after operation to evaluate curative effect.Results 278 patients received a total of 295 BEIS endoscopic surgery,of which 269(91.2%)times without adjusting the entry point,26 times(8.8%)needed to adjust.The average time of puncture was 20.6 minutes.All patients were followed up after discharge,and the follow-up time reached 1 year and above.The VAS scores after the operation were reduced significantly(P<0.05)compare to the preoperation score,especially the last follow-up score.The JOA scores after the operation were gradually increased(P<0.05)compare to the preoperation score,especially the last followup score.At the last follow-up,the excellent and good rate was 86.3%,the effective rate was 96.4%.Conclusion The standardized and patterned BEIS technique has a broader endoscopic operating space,expanding the indications of TESSYS,getting a satisfying clinical curative effect,and deserving further promotion.
作者
王鸿晨
王力文
叶猛
李嵩鹏
WANG Hongchen;WANG Liwen;YE Meng;LI Songpeng(Bei Jing Ren He Hospital,Beijing,China;Hui Zhou Hospital of TCM,Guangdong,China)
关键词
椎间孔镜
BEIS技术
穿刺定位
减压方法
腰椎退行性疾病
transforaminal endoscope
BEIS technique
BEIS tunnel
puncture
decompression
lumbar degenerative disease
