下压式扩孔技术在经皮椎间孔镜手术治疗伴高髂嵴L5/S1椎间盘突出症中的应用

Application of press-down enlargement of foramen in percutaneous transforminal endoscopic discectomy in treatment of high iliac crest L5/S1 disc herniation

摘要:

目的 探讨下压式扩孔技术在经皮椎间孔镜手术（PTED）治疗伴高髂嵴L₅/S₁椎间盘突出症中的临床应用价值。方法 收集2016年10月－2019年1月秦皇岛市第二医院和复旦大学附属中山医院伴高髂嵴的L₅/S₁椎间盘突出症患者45例，在PTED中应用下压式扩孔技术治疗。记录患者的穿刺次数、透视次数、建立工作通道时间和手术总时间。术前、术后1 d、术后3个月、术后6个月和末次随访时患者腰痛和腿痛缓急程度采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）进行评估，末次随访时按MacNab标准评价患者临床疗效。结果 所有患者手术均顺利完成。穿刺一次成功率为91.11%；透视次数5～18次，平均（13.36±4.77）次；建立工作通道时间15～28 min，平均（20.36±6.17）min；手术总时间50～98 min，平均（75.39±19.68）min。患者术后腰痛及腿痛较术前明显好转，腰椎功能较术前明显改善，术后1 d、术后3个月、术后6个月及末次随访时腰痛和腿痛VAS及ODI评分均较术前均明显降低（P < 0.05）。按MacNab标准评价疗效，优40例，良3例，可1例，差1例，优良率为95.56%。结论 下压式扩孔技术应用于PTED，具有操作简单、穿刺成功率高、安全有效、并发症少、射线暴露少和临床效果好等优点，值得临床推广应用。

Abstract:

Objective To investigate the clinical value of press-down enlargement of foramen technique in percutaneous transforminal endoscopic discectomy (PTED) for high iliac crest L₅/S₁ disc herniation.Methods From October 2016 to January 2019, 45 patients with high iliac crest L₅/S₁ disc herniation were treated with press-down enlargement of foramen technique in PTED surgery. Record the data as follows: the number of puncture, the number of X-ray, the time of set up the working channel and the total time of the operation. Visual analogue scale (VAS), Oswestry disability index (ODI) were used to evaluate low back pain and leg pain before surgery, 1 day after surgery, 3 months after surgery, 6 months after surgery and at the last follow-up. MacNab standard was used to evaluate the clinical efficacy at the last follow-up.Results The surgery of all these patients completed successfully. The success rate of one puncture was 91.11%. The number of X-ray was 5 ~ 18 times, with an average of (13.36 ± 4.77) times. The time to establish the working channel was 15 ~ 28 min, with an average of (20.36 ± 6.17) min. The total operation time was 50 ~ 98 min, with an average of (75.39 ± 19.68) min. The postoperative low back pain and leg pain were significantly relieved and lumbar function was significantly improved compared with that before surgery. VAS score and ODI of lower back pain and leg pain were significantly lower at the 1st day, 3 months after surgery, 6 months after surgery and the last follow-up than before surgery (P < 0.05). According to the standard efficacy evaluation of MacNab, 40 cases were excellent, 3 cases were good, 1 case was general, and 1 case was poor. The excellent and good rate was 95.56%.Conclusion There were several features such as more simple, high puncture success rate, high safety and effective, less complications, fewer X-ray, more excellent clinical effect and so on to use press-down enlargement of foramen technique in PTED. The press-down enlargement of foramen technique is a good surgical option worthy of clinical popularization and application.