导杆漂移技术在经皮椎间孔镜治疗腰椎间盘突出症中的应用

Application of guide rod drift technique in treatment of lumbar disc herniation with percutaneous transforaminal

摘要:

目的 探讨导杆漂移技术在经皮椎间孔镜治疗腰椎间盘突出症（LDH）中的有效性、安全性、可行性和应用价值。方法 回顾性分析2017年10月－2018年12月该科收治的单节段LDH患者48例，分别采用常规穿刺置管（常规组，n = 23）和导杆漂移技术置管（导杆组，n = 25），根据术前、术后1 d、术后3个月和术后6个月的视觉模拟评分（VAS）、Oswestry功能障碍指数评分（ODI）和改良MacNab标准评估症状改善程度和临床疗效，比较两组透视次数、穿刺时间和手术时间。结果 48例患者手术均顺利完成并获随访，平均随访时间（12.0±2.3）个月。导杆组中，1例因椎间盘钙化切除不彻底，术后症状无明显改善，另有1例术中发生患侧L₅行走神经根不完全性损伤，术后出现下肢肌力减弱。所有患者无硬膜囊、腹腔脏器、血管损伤和感染等并发症发生。常规组中，1例术后3 d因打喷嚏引起复发，分别于术后第5和6天相同入路再次行椎间孔镜手术，翻修后症状完全消失。导杆组透视次数、穿刺时间和手术时间均明显少于常规组（P < 0.05）。两组术前术后各时点VAS评分和ODI评分比较，差异均无统计学意义（P > 0.05）。两组术后各时点VAS评分和ODI评分与术前比较，均明显降低。末次随访采用改良MacNab标准评价，其中优36例，良7例，可4例，差1例，优良率为89.58%。结论 导杆漂移技术应用于经皮椎间孔镜手术中，具有安全、高效和操控性强的优点，能明显减少透视次数和辐射量，缩短穿刺和手术时间，值得临床推广应用。

Abstract:

Objective To explore the effectiveness, security, feasibility and application value of guide rod drift technology in percutaneous endoscopic discectomy.Methods 48 patients with single segment lumbar disc herniation were recruited for retrospective study from October 2017 to December 2018. Conventional puncture (conventional group, n = 23) and guide rod drift technique (guide rod group, n = 25) were applied respectively to place the working sleeve. VAS score, ODI score and modified MacNab standard preoperative, at 1 d, at 3 and 6 months postoperation were used to evaluate the degree of symptom improvement and clinical efficacy, and compared the fluoroscopy times, puncture time and operation time between the two groups.Results All the 48 cases were successfully completed and followed up with an average follow-up time of (12.0 ± 2.3) months. 1 case of the guide rod group was not improved because of incomplete calcified disc excision after operation, another case had incomplete paraplegia of L₅ nerve root during operation and occurred a decline of muscle strength of lower extremities after operation. 1 case of the conventional group recurrence at 3 d postoperation caused by sneezing, both of them received revision surgery in the same way of percutaneous endoscopic lumbar discectomy at 5 and 6 d respectively after surgery, the clinical symptoms were completely resolved after renovation. There were no dural sac, abdominal viscera and vascular injury, infection and other complications. The number of fluoroscopy, puncture time and operation time of guide rod group were significantly less than those of the conventional group (P < 0.05). There were no significant difference in VAS score and ODI between the two groups (P > 0.05). VAS score and ODI score at different time point after operation in the two groups were significantly lower than that before surgery. The modified MacNab standard was used in the final follow-up, there were 36 excellent cases, 7 cases good, 4 cases acceptable and 1 case poor, the effective rate was 89.58%.Conclusion The technique of guide rod drifting is safety, efficient and controllable in percutaneous foraminal surgery, which can significantly reduce the number of fluoroscopy and radiation, shorten the puncture and operation time, and deserve the clinical expansion.