吴星火;杨操;郜勇;张宇坤;华文斌;王琨;宋雨;涂计;邵增务;杨述华;

• 1:华中科技大学同济医学院附属协和医院骨科

摘要(Abstract)：

[目的]探讨全麻下可视化椎间孔镜技术治疗腰椎间盘突出症的可行性及安全性。[方法] 2015年1月～2017年1月本科收治腰椎间盘突出症患者94例,均采用椎间孔镜技术进行治疗。其中,常规组30例,采用局麻、常规定位和椎间孔镜操作;可视化组64例,采用全麻,可视化定位与操作技术。评估患者的术中疼痛、手术时间、透视时间、住院时间、术后并发症及恢复情况。[结果]两组患者均顺利完成手术,两组均未出现脊髓及神经根损伤等并发症。两组在手术时间、伤口大小、术中出血量、住院天数的差异均无统计学意义(P>0.05)。然而,常规组患者多数术中有不同程度的疼痛,而可视化组患者因全麻术中无疼痛,常规组术中射线曝露时间明显长于可视化组,差异有统计学意义[(10.12±3.24) s vs (1.06±0.18) s,P<0.05]。两组患者平均随访6～12个月,末次随访时,两组的VAS和ODI均显著减少,与术前相比差异有统计学意义(P<0.05),但末次随访时,两组间VAS和ODI的差异均无统计学意义(P>0.05)。[结论]全麻下可视化椎间孔镜技术可显著减轻患者术中疼痛,减少术中X线透视量,提高患者围手术期舒适度。

关键词(KeyWords)： 可视化;椎间孔镜;腰椎间盘突出症

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(编号:81541056)

作者(Author): 吴星火;杨操;郜勇;张宇坤;华文斌;王琨;宋雨;涂计;邵增务;杨述华;

Email:

DOI:

参考文献(References)：

• [1]周跃,李长青,王建,等.椎间孔镜YESS和TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
• [2]范国鑫,吴信波,管晓菲,等.经椎间孔内镜技术穿刺路径辅助定位器的设计与临床应用[J].中国脊柱脊髓杂志,2016,26(31):218-224.
• [3]Cho JY,Lee SH,Lee HY.Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation:floating retraction technique[J].Minim Invasive Neurosurg,2011,54(5-6):214-218.
• [4]Ahn Y.Transforaminal percutaneous endoscopic lumbar discectomy:technical tips to prevent complications[J].Expert Rev Med Devices,2012,9(4):361-366.
• [5]Ruetten S,Komp M,Merk H,et a1.Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique:a prospective,randomized,controlled study[J].Spine(Phila Pa 1976),2008,33(9):931-939.
• [6]聂鸿飞,曾建成,宋跃明,等.经皮椎板间人路与经皮椎间孔入路内窥镜下椎间盘切除术治疗L5/S1椎间盘突出症的短期疗效比较[J].中国脊柱脊髓杂志,2016,26(3):225-232.
• [7]Li XC,Zhong CF,Deng GB,et a1.Endoscopic procedures versus traditional discectomy surgery for discectomy:a systematic review and meta-analysis of current globm clinical trialsl[J].Pain Physician,2016,19(3):103-118.
• [8]Hoogland T,Schubert M,Miklitz B,et a1.Transforaminal posterolateral endoscopic disceetomy with or without the combination of a low-dose chymopapain:a prospective randomized study in 280consecutive cases[J].Spine(Phila Pa 1976),2006,31(24):E890-897.
• [9]周跃,李长青,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
• [10]李长青,周跃,王建,等.经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症[J].中国脊柱脊髓杂志,2013,23(3):193-197.
• [11]赵宏,李纯志,方煜,等.椎间孔镜maxMore技术治疗青少年腰椎间盘突出症[J].中国微创外科杂志,2017,17(5):432-436.
• [12]Sencer A,Yorukoglu AG,Akcakaya MO,et al.Fully endoscopic interlaminar and transforaminal lumbar discectomy:short-term clinical results of 163 surgically treated patients[J].World Neurosurg,2014,82(5):884-890.
• [13]Ruetten S,Komp M,Merk H,et al.Recurrent lumbar disc herniation after conventional discectomy:a prospective,randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision[J].J Spinal Disord Tech,2009,22(2):122-129.
• [14]Ruetten S,Komp M,Godolias G.A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes:prospective 2-year results of 331 patients[J].Minim Invasive Neurosurg,2006,49(2):80-87.
• [15]Ruetten S,Komp M,Merk H,et al.Use of newly developed instruments and endoscopes:full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach[J].J Neurosurg Spine,2007,6(6):521-530.
• [16]Iida Y,Kataoka O,Sho T,et al.Postoperative lumbar spinal instability occurring or progressing secondary to laminectomy[J].Spine(Phila Pa 1976),1990,15(11):1186-1189.
• [17]Mochida J,Toh E,Nomura T,et al.The risks and benefits of percutaneous nucleotomy for lumbar disc herniation.A 10-year longitudinal study[J].J Bone Joint Surg Br,2001,83(4):501-505.