摘要
[目的]介绍经皮脊柱内镜术(percutaneous spinal endoscopy,PSE)治疗钙化型腰椎间盘突出症的手术技术与初步效果。[方法]2017年01月-2020年10月,对17例钙化型腰椎间盘突出症患者行PSE治疗。按术前CT影像显示责任节段钙化的椎间盘形态,采取相应的手术操作技术。常规建立工作通道,暴露硬膜囊部分边缘及突出钙化的椎间盘,先用直头小髓核钳对椎间盘进行直接减压,再充分显露钙化椎间盘,用骨凿或镜外可视化环锯将钙化物缓慢切除。[结果]所有患者均顺利完成PSE手术,均无并发症发生。术后VAS评分、Oswestry功能障碍指数与术前相比均显著降低(P<0.05)。末次随访,按照改良MacNab标准评定临床效果,优11例,良4例,中1例,差1例,优良率为88.24%(15/17)。[结论]依据钙化的椎间盘不同分型,采取相应的手术操作技巧治疗钙化型腰椎间盘突出症是一种安全有效的微创手术方案。
[Objective] To introduce the surgical technique and preliminary results of percutaneous spinal endoscopy(PSE) for the treatment of calcified lumbar disc herniation. [Methods] From January 2017 to October 2020, 17 patients underwent PSE for calcified lumbar disc herniation. According to calcified disc morphology of the responsible segment on preoperative CT imaging, the corresponding surgical techniques were applied. Establish a working channel routinely to expose the dural sac and protruding calcified intervertebral discs. Decompress the intervertebral discs directly with a straight-head small nucleus pulposus forceps, and then fully expose the calcified intervertebral discs. Remove the calcifications slowly by using an osteotome or an external visualization trephine. [Results] All patients had endoscopy completed successfully without complications. The VAS and ODI scores decreased significantly postoperatively compared with those before operation(P<0.05). At the latest follow-up, the clinical outcomes were grades as excellent in 11 cases, good in 4, fair in 1 and poor in 1, with the excellent and good rate of 88%(15/17), according to the modified MacNab.s criteria. [Conclusion] It is a safe and effective to apply corresponding surgical techniques for calcified lumbar disc herniation according to the types of the lesion.
作者
王凌斌
李俊杰
朱林峰
宋坤锋
WANG Ling-bin;LI Jun-jie;ZHU Linfeng;SONG Kun-feng(Department of Orthopedics,Zhejiang Xinan International Hospital,Jiaxing 314000,China;Intervertebral Disc Center,Henan Third People's Hospital,Zhengzhou450000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2021年第17期1597-1600,共4页
Orthopedic Journal of China
