经皮颈椎间盘髓核摘除术手术器械的改良与应用

Percutanous cervical discectomy with modified instrument and surgical method

目的:探讨应用改良器械行经皮颈椎间盘髓核摘除术(PCD)的安全性及效果。方法:自1994年8月开始,通过对人体颈部解剖与影像学断面图像的对照研究,自行改良设计制作了新的手术器械(包括空心穿刺针、髓核夹取钳及颈椎间冲洗吸引器),以3条成年犬为实验对象,进行PCD操作,观察穿刺的安全性。于1995年5月应用于临床,采用钳取和环锯局部切割相结合方式实现突出部位直接减压并以双腔式冲洗吸引器行椎间隙内0.08～0.1kPa负压吸引术,其中资料完整者252例,共306枚椎间盘。结果:3条试验犬行36次经皮穿刺有1次回血;临床应用病例中经皮穿刺椎间盘过程发现少许回血者13例,胸闷和心前区疼痛2例,撤针后重新穿刺均获成功,顺利完成手术。未发现术后感染和其他严重并发症。结论:改良后的PCD施术方法和手术器械可提高手术的安全性和成功率,从而减轻了施术医师和患者的心理压力,有利于该疗法的应用。

Objective：To discuss the clinical effect and efficasy of self-modified instrument in the treatment of percutaneous cervical discectomy （PCD）.nethod：From August 1994,an anatomic and radiologic research with respect to human cervical was performed.The self-modified surgical instrument included hollow penetration steinler,karrison and suction.The research was performed on 3 adult dogs,the process of its penetration into cervical disc percutanously was noted.On the basis of this,clinical application of this instrument began in May 1995.Finger press and pliers press were used as local press method,associted with hollow needle puncture technology,direct decompression with pliers and local ring-saw was performed to remove the protrusion part,and which was sucted by double cavity wash-draw instrumention under a negative pressure of 0.08-0.1kPa.252 PCD cases with complete documents were reviewed,of these,a total of 306 discs were collected.The follow-up period ranged from 5 months to 24 months,with 34 cases longer than 48 months.Result：Blood reflux was noted in only I of 36 processes in 3 dogs.As for clinical application,blood reflux was noted in 13 cases,another discomfort in 2 cases,all succeeded followed by removal of the needle and try again.No infection or other severe complication was noted.Conclusion：The success rate is enhanced by using this modified instrument,which can decrease the psychological pressures on both doctors and patients.