經皮椎間孔鏡TESSYS技術治療腰椎間盤突出癥18例的近期療效

摘要：目的 評估經皮椎間孔鏡

關鍵詞：椎間孔鏡；腰椎間盤突出癥；射頻消融

The efficacy of 18 Patients with Disc Herniation Percutaneous Transforaminal Endoscopic Discectomy for Lumbar TESSYS

HUA Guo-tian，YUAN Zhi-gang，LAI Mao-wen

（Dongcheng District people's Hospital of City，Dongguan，523007，Guangdong，China）

Abstract：Objective To evaluate the preliminary clinical outcomes of percutaneous transformational endoscope discectomy（PTED）in treating lumbar disc herniation after conservative treatment.Methods Totally 18 patients with single lumbar disc herniation failed in conservative treatment and then received posterolateral （PTED Clinical outcomes were evaluated by visual analogue scale（VAS），Oswestry disability index（ODI）and modified Macnab criteria before and after the operation.Results The postoperative VAS scores（3.6±0.8，3.2±0.7，2.5±0 .6 at 1 day，1 week and 1 months）were significantly lower than preoperative one（8.74±1 4 ， P<0.01）The postoperative ODI（32.2%±8.2%，21.3%±4.9%，18.8%±8.3%at 1 day，1 week， 1 months）were also significantly lower than preoperative one（82.2%±12.6%，P<0.01）.According to the modified Macnab criteria，the therapeutic outcome was excellent in 7 cases，good in 9，fair in 2，and poor in 0.Transient nerve palsy occurred in one patient on day 1 after operation and disappeared after 3 days without special treatment.Conclusion The preliminary study shows that PTED is safe and effective in treating lumbar discherniation.

Key words：Transformational endoscope；Lumbar intervertebral disc herniation；Radiofrequency

腰椎間盤脫出癥（lumbar disc herniation， LDH）是臨床的常見病，多發病，其治療方法和療效一直是外科醫生的一個熱門話題。在脊柱手術，后路切開手術方法被廣泛應用于LDH的治療。用更新的技術和手術器械的進步，微創手術已逐漸應用于臨床，椎間孔鏡（椎間孔鏡下脊柱內固定系統， TESSYS ）技術是目前比較流行的微創技術。

1資料與方法

1.1一般資料

1.2手術器械 THESSYS脊椎椎間孔內窺鏡系統（德國齊柏林公司）和熔化溫度低的射頻機（埃爾曼公司在美國） 。

1.3方法 手術衛生床邊，患者腰墊，使腰椎后正中線上平行于床面。靜脈滴注氟比洛芬酯100 mg輔助鎮痛，必要時1～2 mg靜脈注射咪達唑侖鎮靜適中。術前用定位網絡下的C形臂X線透視確定椎間盤體表投影和標記病理變化。取髂前上棘1公分責任的椎間盤水平線上和脊柱中線附近后10～12 cm為進針點開放。皮下至肌層注射1%利多卡因行穿刺的方法一步步浸潤麻醉。穿刺針與軀干矢狀面成10°～20°角在X線透視下根據椎間盤椎間孔的病理變化緩緩刺入。用22號穿刺針注射碘在海醇注射液中的椎間盤（歐洲是帕克）和亞甲基藍1∶9混合注射2～3 mL，磁盤映像染色，疼痛和可以復制的測試，誘發腰腿痛，四肢放射性疼痛的患者，以核實診斷。針頭插入導管穿刺針抽取和導絲刀切割皮膚約7 mm，沿螺套膨脹套管，分步實施與環鉆擴孔骨組織，最終投入工作套管，確定9內鏡右后殼位置連接，通過顯示面板髓核鉗在椎間盤后半部藍染組織，倒退椎間孔鏡，探針以除去藍染突出周圍神經根組織劑，以確保該神經根減壓，充分沖洗殘余，髓核射頻出血牽引裝置后，縫合針，結束[1-2]。……