[1]宋博,王海羽,李国闯,等.导杆漂移技术穿刺置管在PTED治疗L5/S1椎间盘突出症中的应用[J].中国临床神经外科杂志,2022,27(11):905-908.[doi:10.13798/j.issn.1009-153X.2022.11.008]
　SONG Bo,WANG Hai-yu,LI Guo-chuang,et al.Application of working channel placement assissted by guide-rod drift technique to percutaneous transforminal endoscopic discectomy for patients with L5/S1 disc herniation[J].,2022,27(11):905-908.[doi:10.13798/j.issn.1009-153X.2022.11.008]
点击复制

导杆漂移技术穿刺置管在PTED治疗L5/S1椎间盘突出症中的应用()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年11期
页码:
905-908
栏目:
论著
出版日期:
2022-11-30

文章信息/Info

Title:
Application of working channel placement assissted by guide-rod drift technique to percutaneous transforminal endoscopic discectomy for patients with L5/S1 disc herniation
文章编号:
1009-153X（2022）11-0905-04
作者:
宋博; 王海羽; 李国闯; 宋磊磊; 马远
473009 河南，南阳市中心医院骨一科（宋博、王海羽、李国闯、宋磊磊、马远）
Author(s):
SONG Bo;  WANG Hai-yu;  LI Guo-chuang;  SONG Lei-lei;  Ma Yuan
Department of Orthopaedics, Nanyang Central Hospital, Nanyang 473009, China
关键词:
腰椎间盘突出症; L5~S1椎间盘; 经皮椎间孔镜下椎间盘切除术; 导杆漂移技术
Keywords:
Lumbar disc herniation;  L5/S1 disc herniation;  Percutaneous transforminal endoscopic discectomy
分类号:
R681.5+7;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2022.11.008
文献标志码:
A
摘要:
目的 探讨导杆漂移技术穿刺置管在经皮椎间孔镜下椎间盘切除术（PTED）治疗L5/S1椎间盘突出症中的安全性和有效性。方法 回顾性分析2019年1月~2020年12月采用导杆漂移技术辅助PTED治疗的34例L5/S1椎间盘突出症的临床资料。术前、术后1个月、3个月、末次随访时，采用疼痛视觉模拟量表（VAS）评分评估病人腰部、腿部疼痛程度，采用Oswestry功能障碍指数（ODI）评估病人功能恢复情况。末次随访时，采用改良Macnab分级标准评定优良率。结果 均顺利完成手术，透视次数为（12.65±4.51）次；通道建立时间为（24.06±4.07）min；手术时间为（63.82±8.96）min。随访时间为14~30个月，平均（20.09±4.29）个月。术后腰痛、腿痛VAS评分及ODI评分均明显降低（P<0.05）。末次随访时，根据改良MacNab标准：优24例，良8例，可2例；优良率为94.12%。结论 应用PTED治疗L5/S1椎间盘突出症，经皮椎间孔镜导杆漂移技术能安全、有效地置管，降低穿刺难度，提高手术安全性，手术效果良好。
Abstract:
Objective To explore the safety and effectiveness of working channel placement assissted by guide-rod drift technique during percutaneous transforminal endoscopic discectomy (PTED) for the patients with L5/S1 disc herniation (L5/S1 DH). Methods A retrospective analysis was performed on the clinical data of 34 patients with L5/S1 DH treated with PTED from January 2019 to December 2020. During the operation, the working channel was placed by guide-rod drift technique. The visual analogue scale (VAS) was used to evaluated the low back and leg pain, the Oswestry disability index (ODI) was used to evaluate the neurological function,and the modified MacNab criteria was used to evaluated the efficacy. Results All the patients successfully completed the procedure. The mean number of fluoroscopy was (12.65±4.51) times, the mean time of channe establishment was (24.06±4.07) minutes, and the mean operation time was (63.82±8.96) minutes. The follow-up time ranged from 14 months to 30 months, with a mean time of (20.09±4.29) months. The VAS and ODI scores were significantly reduced after operation (P<0.05). At the last follow-up, excellent outcomes were achieved in 24 patients, good in 8, and fair in 2 according to the modified MacNab criteria. The rate of excellent and good outcomes was 94.12%. Conclusions For the patients with L5/S1 DH undergoing PTED, working channel placement assissted by guide-rod drift technique is safe and effective, which can reduce the difficulty of puncture, improve the safety of the operation, and obtain good outcomes.

参考文献/References:

[1] Gadjradj PS, Harhangi BS, Amelink J, et al. Percutaneous transforaminal endoscopic discectomy versus open micro-discectomy for lumbar disc herniation: a systematic review and meta-analysis [J]. Spine, 2021, 46(8): 538-549.
[2] 李　涛，张同会，谢　维，等. 可视化环锯辅助下椎间孔镜技术治疗脱出游离型腰椎间盘突出症[J]. 中国临床神经外科杂志，2020，25（9）：597-599.
[3] Jing Z, Li L, Song J. Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy for upper lumbar disc herniation: a retrospective comparative study [J]. Am J Transl Res, 2021, 13(4): 3111-3119．
[4] Ahn Y, Lee SG, Son S, et al. Transforaminal endoscopic lumbar discectomy versus open lumbar microdiscectomy: a comparative cohort study with a 5-year follow-up [J]. Pain Phys, 2019, 22(3): 295-304.
[5] 张志朋，汪冬生，刘合振. 不同入路椎间孔镜术治疗腰椎间盘突出症的疗效及安全性比较[J]. 中国临床神经外科杂志，2018，23（11）：724-726.
[6] Sakti YM, Khadafi RN, Tarsan AK, et al. Transforaminal endoscopic lumbar discectomy for L5-S1 disc herniation: a case series [J]. Int J Surg Case Rep, 2021, 83: 105967.
[7] Chen KT, Wei ST, Tseng C, et al. Transforaminal endoscopic lumbar discectomy for L5-S1 disc herniation with high iliac crest: technical note and preliminary series [J]. Neurospine, 2020, 17(Suppl 1): S81-S87.
[8] Ao S, Wu J, Zheng W, et al. A novel targeted foraminoplasty device improves the efficacy and safety of foraminoplasty in percutaneous endoscopic lumbar discectomy: preliminary clinical application of 70 cases [J]. World Neurosurg, 2018, 115: e263-e271.
[9] Srinivasan D, Than KD, Wang AC, et al. Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure [J]. World Neuro-surg, 2014, 82(6): 1337-1343.
[10] 蒋协远，王大伟. 骨科临床疗效评价标准[M]. 北京：人民卫生出版社，2005. 119-121.
[11] Macnab IAN. Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients [J]. JBJS, 1971, 53(5): 891-903.
[12] Alvi MA, Kerezoudis P, Wahood W, et al. Operative approaches for lumbar disc herniation: a systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries [J]. World Neurosurg, 2018, 114: 391-407.
[13] Chen BL, Guo JB, Zhang HW, et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis [J]. Clin Rehabil, 2018, 32(2): 146-160.
[13] 金丹杰，徐南伟，赵国辉，等. 经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究[J]. 中国微创外科杂志，2017，17（6）：491-494.
[14] Zhang B, Liu S, Liu J, et al. Transforaminal endoscopic discectomy versus conventional microdiscectomy for lumbar discherniation: a systematic review and meta-analysis [J]. J Orthop Surg Res, 2018, 13(1): 1-9.
[15] 翟亚业，秦晓彬，孟祥翔，等. 腰椎间盘突出症经皮椎间孔镜术后类固醇激素的应用对比：硬膜外给药与静脉给药[J]. 中国临床神经外科杂志，2022，27（6）：486-488.
[16] Nie H, Zeng J, Song Y, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up [J]. Spine, 2016, 41: B30-B37.
[17] Fujita M, Kawano H, Kitagawa T, et al. Preoperative design for the posterolateral approach in full-endoscopic spine surgery for the treatment of L5/S1 lumbar disc herniation [J]. Neurospine, 2019, 16(1): 105-112.
[18] Chen J, Jing X, Li C, et al. Percutaneous endoscopic lumbar discectomy for L5/S1 lumbar disc herniation using a transforaminal approach versus an interlaminar approach: a systematic review and meta-analysis [J]. World Neurosurg, 2018, 116: 412-420.
[19] Kong W, Chen T, Ye S, et al. Treatment of L5-S1 intervertebral disc herniation with posterior percutaneous full-endoscopic discectomy by grafting tubes at various positions via an interlaminar approach [J]. BMC Surg, 2019, 19: 1-8.
[20] 王作伟，菅凤增，王兴文，等. 经皮椎间孔镜技术治疗腰椎间盘突出症：椎间孔入路和椎板间入路的对照研究[J]. 中华神经外科杂志，2016，32（12）：1214-1219.
[21] 甘　璐，李　沫，杜俊杰，等. 经髂骨钻孔入路椎间孔镜手术与传统后入路椎板开窗髓核摘除术治疗高髂嵴L5/S1椎间盘突出症的短期疗效比较[J]. 微创医学，2020，15（2）：134-137，170.
[22] Liu J, Wu J, Zhang H, et al. Application of a targeted and quantificational foraminoplasty device in percutaneous transforaminal endoscopic discectomy for L5-S1 disc herniation: preliminary clinical outcomes [J]. J Orthop Surg Res, 2021, 16(1): 1-9.
[23] 王作伟，陈　赞，王　凯，等. 经皮椎间孔入路椎间孔镜治疗L5~S1腰椎间盘突出症[J]. 中华医学杂志，2020，100（4）：270-273.
[24] 赵　杉，张海龙，管晓菲，等. 椎间孔镜手术术中导丝断裂并发症1例报道[J]. 实用骨科杂志，2015，21：863-864.

相似文献/References:

[1]舒　伟　李勇杰　陶　蔚　卢　光　张佳星　倪　兵　孙　涛　朱宏伟.经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症[J].中国临床神经外科杂志,2018,(01):4.[doi:10.13798/j.issn.1009-153X.2018.01.002]
　SHU Wei,LI Yong-jie,TAO Wei,et al.Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation[J].,2018,(11):4.[doi:10.13798/j.issn.1009-153X.2018.01.002]
[2]宋应豪　曾光亮　钱志远　孔祥宇　李如军.可撑开通道系统辅助下显微手术治疗腰椎间盘突出症[J].中国临床神经外科杂志,2018,(01):7.[doi:10.13798/j.issn.1009-153X.2018.01.003]
　SONG Ying-hao,ZENG Guang-liang,QIAN Zhi-yuan,et al.Treatment of lumbar disc herniation with microsurgery assisted by Caspar expandable channel system (report of 30 cases)[J].,2018,(11):7.[doi:10.13798/j.issn.1009-153X.2018.01.003]
[3]张志朋　汪冬生　刘合振.不同入路椎间孔镜术治疗腰椎间盘突出症的疗效及安全性比较[J].中国临床神经外科杂志,2018,(11):727.[doi:10.13798/j.issn.1009-153X.2017.11.007]
　ZHANG Zhi-peng,WANG Dong-sheng,LIU He-zhen.Curative effects intervertebral foraminoscopy via posteriolateral approach on lumbar disc herniation and its safeness compared with that via posterior approach[J].,2018,(11):727.[doi:10.13798/j.issn.1009-153X.2017.11.007]
[4]谭林英　徐　峰.经皮椎间孔镜术治疗腰椎间盘突出症合并后纵韧带骨化的疗效分析[J].中国临床神经外科杂志,2018,(12):788.[doi:10.13798/j.issn.1009-153X.2018.12.007]
　TAN Lin-ying,XU Feng.Treatment of lumbar disc herniation with ossification of posterior longitudinal ligament by percutaneous intervertebral foramen endosdcope surgery[J].,2018,(11):788.[doi:10.13798/j.issn.1009-153X.2018.12.007]
[5]王　璨　喻军华　袁学刚.骶管囊肿伴腰椎间盘突出症的手术治疗[J].中国临床神经外科杂志,2018,(12):804.[doi:10.13798/j.issn.1009-153X.2018.12.014]
[6]王海澎　杨希孟　朱宏伟　菅凤增　王大明　王作伟.经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析[J].中国临床神经外科杂志,2020,(06):352.[doi:10.13798/j.issn.1009-153X.2020.06.005]
　WANG Hai-peng,YANG Xi-meng,ZHU Hong-wei,et al.Management and outcomes of dural tears during percutaneous endoscopic transforaminal lumbar discectomy for patients with lumbar disc herniation[J].,2020,(11):352.[doi:10.13798/j.issn.1009-153X.2020.06.005]
[7]徐　峰　伍搏宇　熊承杰　魏坦军　席金涛　赵东东　黄壁旺.靶向椎间孔成形技术与常规穿刺置管技术治疗腰椎间盘突出症的对比研究[J].中国临床神经外科杂志,2020,(08):503.[doi:10.13798/j.issn.1009-153X.2020.08.003]
　XU Feng,WU Bo-yu,XIONG Cheng-jie,et al.Comparison of targeted foraminoplasty and conventional puncture catheter technique during percutaneous transforaminal endoscopic discectomy for patients with lumbar disc herniations[J].,2020,(11):503.[doi:10.13798/j.issn.1009-153X.2020.08.003]
[8]李　涛　张同会　谢　维　李　莹　吴从俊　刘　鏐　唐　谨　李绪贵.可视化环锯辅助下椎间孔镜技术治疗脱出游离型腰椎间盘突出症[J].中国临床神经外科杂志,2020,(09):597.[doi:10.13798/j.issn.1009-153X.2020.09.007]
　LI Tao,ZHANG Tong-hui,XIE Wei,et al.Visual circular saw-assisted percutaneous transforaminal endoscopic discectomy for patients with prolapsed free lumbar disc herniation[J].,2020,(11):597.[doi:10.13798/j.issn.1009-153X.2020.09.007]
[9]翟亚业,秦晓彬,孟祥翔,等.腰椎间盘突出症经皮椎间孔镜术后类固醇激素的应用对比：硬膜外给药与静脉给药[J].中国临床神经外科杂志,2022,27(06):486.[doi:10.13798/j.issn.1009-153X.2022.06.018]
[10]何航,马俊,熊承杰,等.腰椎间盘突出症MSU分类与神经功能障碍的关系[J].中国临床神经外科杂志,2023,28(04):234.[doi:10.13798/j.issn.1009-153X.2023.04.003]
　HE Hang,MA Jun,XIONG Cheng-jie,et al.Relationship between Michigan State University (MSU) classification and neurological dysfunction of patients with lumbar disc herniation[J].,2023,28(11):234.[doi:10.13798/j.issn.1009-153X.2023.04.003]

备注/Memo

备注/Memo:
（2022-07-20收稿，2022-10-22修回）
更新日期/Last Update: 2022-12-31