亚甲蓝在经皮椎间孔镜TESSYS技术中的应用价值

Application of methylene blue in percutaneous endoscopic lumbar discectomy

目的探讨亚甲蓝在经皮椎间孔镜TESSYS技术中的临床应用价值及注意事项。方法回顾性分析自2016-01—2017-12采用经皮椎间孔镜TESSYS技术治疗的186例腰椎间盘突出症或腰椎管狭窄症,术中用亚甲蓝对责任椎间盘染色,细致、彻底摘除蓝染椎间盘组织。比较术前、术后3 d、术后1个月、术后3个月疼痛VAS评分与ODI指数。术后3个月采用MacNab标准评估疗效。结果 186例均获得至少3个月随访。2例出现美蓝尿(尿液呈蓝色),尿液颜色均在术后24 h内恢复正常。5例于术后2个月内复发,其中4例再次行经皮椎间孔镜髓核摘除术,1例行腰椎微创融合内固定术。术后3个月采用MacNab标准评估临床疗效:优134例,良35例,可12例,差5例,优良率90.9%。术后3 d、1个月、3个月疼痛VAS评分、ODI指数均较术前降低,术后1个月较术后3 d降低,术后3个月较术后1个月降低,差异有统计学意义(P <0.05)。结论经皮椎间孔镜TESSYS技术操作过程中应用亚甲蓝对退变椎间盘组织染色,能使术者在镜下及时、准确地辨别致压靶点,充分摘除病变髓核组织。此方法可提高手术安全性,增强术者信心,改善手术效果。

Objective To assess the clinical values and cautions of methylene blue in percutaneous endoscopic lumbar discectomy.Methods From January 2016 to December 2017,a total of 186 patients with lumbar disc herniation or lumbar spinal stenosis were retrospectively analyzed.All these patients were treated by percutaneous endoscopic lumbar discectomy.The responsible intervertebral disc was dyed by methylene blue during operation,and blue-stained intervertebral disc tissue was removed carefully and thoroughly.The clinical outcome data were evaluated with visual analog scale(VAS)and modified Oswestry disability index(ODI)before and 3 days,1 month,3 months after operation.MacNab’s criterion was employed to evaluate the clinical results 3 months after surgery.Results All 186 patients were followed up for at least 3 months.The color of urine in 2 patients was blue and gradually returned to normal within 24 hours postoperatively.Five patients recurred within 2 months after operation,of which 4 patients were re-treated by percutaneous endoscopic lumbar discectomy and 1 patient was treated with minimally invasive transforaminal lumbar interbody fusion.The clinical efficacy was evaluated by MacNab criteria at 3 months after operation:excellent in 134 cases,good in 35 cases,fair in 12 cases and poor in 5 cases.The excellent and good rate was 90.9%.The VAS score and ODI index at 3 days,1 month and 3 months postoperatively were lower than those before the operation,and at 1 month postoperatively,they were lower than those at 3 days postoperatively,and at 3 months postoperatively,they were lower than those at 1 month postoperatively.All of these differences are statistically significant(P<0.05).Conclusion The dyeing of the degenerative intervertebral disc tissue by methylene blue in the process of percutaneous endoscopic lumbar discectomy enables the operator to identify the target of nerve compression in time and accurately under the endoscopy,improve the safety of the operation,improve the effect of the operation and enhance the confidence of the operator.