CT引导+内窥镜治疗腰椎间盘突出症的入路设计及应用

CT guidance & percutaneous transforaminal endoscopic discectomy:approach design and clinical application for lumbar disc herniation

[目的]探讨CT引导下内窥镜工作套管置入的入路设计及应用。[方法]根据不同部位和类型的腰椎间盘突出,采用了六种手术入路,按照"角""面""点""向""度"完成入路设计、量化和标记;在CT引导下完成工作套管置入;在内窥镜下完成手术。[结果]临床应用512例,术后随访时间1～20个月,平均7.3个月;JOA评分:术前(11.90±4.0)分,术后1周(26.8±2.7)分,末次随访(26.9±3.2)分,术前术后差异有统计学意义(P<0.001);优450例,良33例,一般15例,差14例,优良率94.3%;术后复发11例,6例行二次椎间孔镜术,5例采取开放性手术;并发症:脑脊液漏4例,经平卧、补液等均治愈;肢体遗留麻木23例;有神经根损伤症状1例。[结论]该术式具有安全、精准、微创、高效,初学者易掌握,术者不受X线伤害,减少髓核遗漏等优点。

[Objective]To investigate the approach design of working cannula and clinical application of CT guidance percutaneous transforaminal endoscopic discectomy.[Methods]Six approaches were selected according to different parts and types of disc herniation.Designing of approaches,quantifying and marking were completed by ＂angle＂,＂level＂,＂point＂,＂direction＂and ＂degree＂.Working cannula was placed through CT guidnnce and operated in transforaminal endoscopy.[Results]Totally 512 patients underwent surgery and the follow-up period was 7.3 months（range 1 to 20 months）.Mean JOA scores was improved from 11.90±4.0 before the surgery to 26.8±2.7 one week after the surgery,while 26.9±3.2 at final follow-up,which showed statistical significance（P〈0.001） According to JOA score,94.3% of the patients showed excellent and good results（excellent in 450,good in 33,fair in 15,poor in 14）.The recurrence rate in the first six months was 3.6%（11 patients）,six patients underwent transforaminal endoscopic discectomy and five patients had open surgery.[Conclusion]CT guidance percutaneous transforaminal endoscopic distectomy has the advantages of security,precision,minimally invasive and effective.The surgeon can avoid the X-ray radiation,and effectively reduce the pulposus missing.