椎间孔一次成形技术在腰椎脊柱内镜中的应用

Technique of intervertebral foraminoplasty just once in percutaneous endoscopic lumbar discectomy

[目的]回顾性分析椎间孔一次成形技术在经皮脊柱内镜下椎间盘切除术(PELD)中的临床应用效果及术中技巧。[方法]2015年5月~2016年5月,在64例的PELD手术中应用椎间孔一次成形技术,患者平均年龄42.4岁(19~72岁)。术中采用1根直径2.0 mm克氏针作为穿刺针,并直接用直径6.3 mm环锯对下位椎体的上关节突进行一次成形,扩大椎间孔。[结果]所有患者顺利接受手术,手术时间平均(99.32±15.54)min,术中透视次数平均为(8.00±2.14)次。所有患者均获得随访,平均随访时间8.23个月(6~15个月)。术后各时间点VAS评分及ODI评分较术前均有显著改善,差异有统计学意义(P<0.001)。至末次随访时疗效与术后第1 d相当,优良率93.75%。[结论]在PELD术中应用椎间孔一次成形技术,可取得良好的治疗效果,既简化了手术过程,又减少了放射暴露,适合推广应用。

[Objective] To explore of the technique and outcome of intervertebral foraminoplasty just once in percutaneous endoscopic lumbar discectomy （PELD）. [Method] From May 2015 to May 2016, 64 patients, aged from 19 to 72 years with a mean of 42.4 years, underwent PELD with intervertebral foraminoplasty just once. During the PELD, a 2.0 mm in diameter Kirschner wire was used as the puncture needle to guide a 6.3 mm circular saw to cut the superior articular process of the lower vertebrae directly just one time for the intervertebral foraminoplasty. [Results] All the patients had operation performed smooth- ly, with operation time of （99.3±15.5） min on average and frequency of fluoroscopy of （8±2.1） times. All of them were followed up for 6 to 15 months with a mean of 8.2 months. Both the VAS and ODI scores statistically decreased compared the data preop- eratively with those at each time point postoperatively （P〈0.01）. The outcomes at the latest follow-up was comparable to those at the first day postoperatively, with the excellent and good rate of 93.75%. [Conclusion] The technique of intervertebral forami- noplasty just once in PELD does achieve satisfactory outcomes, with advantages of simplified surgical procedure and reduced the radiation exposure.