局部麻醉下经皮摘除治疗极外侧型腰椎间盘突出症

Percutaneous endoscopic discectomy for extralateral lumbar disc herniation under local anesthesia

目的:探讨局部麻醉下后外侧入路椎间盘镜下经皮摘除,治疗极外侧型腰椎间盘突出症的手术技术、临床效果及适应证选择。方法:患者俯卧位,棘突旁开10～15cm做一个0.7cm纵行皮肤切口。C臂X线机引导下,从Kambin氏三角穿刺椎间盘置入导丝。工作套管逐级扩张,显露极外侧的椎间盘组织,在椎间盘镜下予以摘除。结果:本组10例,男6例、女4例,平均年龄57.6岁。平均手术时间50min,平均术中出血5mL。平均住院3d,全组手术切口均一期愈合。随访时间6个月～3年。治疗前Oswestry为(58±19)分,治疗后为(12±7)分,差异有显著性(P<0.01)。结论:该手术方法入路简单,局部麻醉创伤小,手术视野清楚,操作精细,能达到优良的手术效果,是治疗极外侧椎间盘突出的较好术式。

Objective To investigate percutaneous endoscopic discectomy for extralateral lumbar disc herniation under local anesthesia and its efficacy. Methods A longitudinal skin incision of 0.7 cm in length 10 to 15 cm close to the spinous process was performed in the patients under the prone position. Under the guidance of the C-Arm X-ray, a guide wire was placed in the intervertebral disc space via the Kambin triangle. The tissue of extralateral lumbar disc was exposed by expansion of the tubes and then removed endoscopically, Results 6 male and 4 female patients with an average age of 57.6 years were included in this study. The average duration of surgery was 50 min, the intraoperative bleeding was 5 mL, and the average length of hospital stay was 3 days. Oswestry scale was 58 ± 19 preoperatively but 12 ± 7 postoperatively and T test for the outcomes revealed P 〈 0.01. All patients were followed 6 months to 3 years. Conclusions Percutaneous endoscopic discectomy is a better procedure for extralateral lumbar disc herniation and achieves ideal effectiveness. This procedure is simple and has a clear surgical field but a minor incision.