天津医药 ›› 2017, Vol. 45 ›› Issue (2): 121-124.doi: 10.11958/20170104

• 专题研究-脊柱微创内镜(主编:徐宝山) • 上一篇    下一篇

经皮椎间孔镜技术治疗胸椎间盘突出症的初步体会

刘越, 徐宝山△, 吉宁, 姜洪丰, 杨强   

  1. 天津市天津医院微创脊柱外科
  • 收稿日期:2017-01-22 修回日期:2017-01-24 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail:xubaoshan99@126.com E-mail:yourliuyue@126.com
  • 作者简介:刘越 (1978), 男, 博士, 副主任医师, 主要从事椎间盘修复临床与基础研究
  • 基金资助:
    国家自然科学基金面上项目(31670983, 81272046); 天津市自然科学基金(15JCYBJC25300); 天津市卫计委攻关课题(14KG121)

Preliminary experience of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation

LIU Yue, XU Bao-shan△, JI Ning, JIANG Hong-feng, YANG Qiang   

  1. Department of Minimally Invasive Spinal Surgery, Tianjin Hospital, Tianjin 300211, China
  • Received:2017-01-22 Revised:2017-01-24 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail:xubaoshan99@126.com E-mail:yourliuyue@126.com

摘要: 目的 探讨经皮椎间孔镜技术治疗胸椎间盘突出症的效果及可行性。方法 对 1 例胸椎间盘突出 (T11/12)患者采取经皮椎间孔镜技术治疗。患者取俯卧位, 局麻 X 线透视下穿刺至病变节段, 正位透视穿刺针尖位于上关节突外缘, 侧位透视针尖在上关节突尖部、 椎间孔后缘, 环锯扩大椎间孔后安置工作通道至椎间隙后缘, 内镜下在后纵韧带腹侧和椎间隙内摘除突出退变的髓核, 直至脊髓完全松解。术后放置引流, 并观察手术结果。结果 手术顺利摘除突出髓核, 脊髓显露清晰, 减压充分。患者术后 2 d 拔出引流管, 3 d 下地活动, 临床症状明显缓解。末次随访时视觉模拟评分(VAS)腿痛由 8 分降至 1 分, Oswestry 功能障碍指数(ODI)自 64 降至 4。MacNab 标准评分为优。结论 胸椎间盘突出症临床上手术风险大、 创伤大, 应用经皮椎间孔镜技术治疗胸椎间盘突出症具有可操作性, 手术创伤小、 恢复快, 短期效果优良。

关键词: 胸椎, 椎间盘移位, 椎间孔镜, 髓核摘除术

Abstract: Objective To investigate the feasibility of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. Methods One patient with thoracic disc herniation involved the level of vertebral segment in T11/12 was treated with percutaneous transforaminal endoscopic spine system and followed up for 1 month. The targeted puncture was performed under local anesthesia and fluoroscopic guidance with patient in prone position. The foramen of T11/12 was enlarged gradually with four trephinations, and the working cannula was inserted transforaminal into the canal. Then the herniation was exposed and removed with full endoscopic technique, including the loosen nucleus pulposus. The dural sac was exposed and released adequately. Drainage was placed during operation. Results The procedure was successfully carried out and the dural sac was completely released. The drainage was removed in the second day of operation. The patient could walk in the third day after operation with obvious relief of back and leg pain. At the follow- up of one month postoperation, the visual analogue scale of leg pain decreased from 8 to 1, and the Oswestry disability index (ODI) decreased from 64 to 4. According to MacNab scale, excellent result was acquired. Conclusion There is the feasibility of the percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. It is a good minimal invasive technique with good results and high technical requirements for surgeons.

Key words: thoracic vertebrae, intervertebral disk displacement, percutaneous transforaminal endoscopy, discectomy