腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术
Summary
在这里, 我们提出了一种新的经神经孔内窥镜下椎间盘摘除术椎间盘的协议。详细介绍了该技术的技术方面、使用范围广、治疗结果184例。
Abstract
经皮内窥镜经神经孔腰椎间盘摘除术 (PETLD) 现在已成为治疗腰椎间盘疾病的标准。有两种技术, 用于引进一个工作套管的光盘-内外内外。本前瞻性研究的目的是描述一种新颖的移动外型方法处理不同类型盘脱垂的技术问题。184例腰椎间盘突出症并发单侧下肢神经根病患者, 在 PETLD 的移动外技术上进行手术。根据他们的椎间盘脱垂类型、视觉模拟量表 (输精管) 腿部疼痛评分、Oswestry 残疾指数 (ODI) 和 Macnab 标准, 对其临床结局进行评估。减压的完整性记录了术后磁共振成像。患者平均年龄为 50 16 岁, 男性/女性比例为2:1。平均随访时间为 19 6 月。共有190腰椎水平 (L1–L2: n = 4, L2–L3: n = 17, L3–L4: n = 27, L4–5: n = 123, 和 L5–S1: n = 19)。分成类型, 患者分布中央: n = 14, paracentral: n = 74, 椎间孔: n = 28, 远的侧向: n = 13, 优越迁移: n = 8, 下等迁移: n = 38, 并且高运河妥协: n = 9。平均手术时间为 35 12 (25-56) 分钟, 平均住院天数为1.2 岁 (1–3) 天。腿部疼痛的输精管评分从7.5 到1提高到 1.7, 0.9。ODI 改进了从 70 8.3 到 23 @ 5。根据 Macnab 标准, 75 例患者 (40.8%) 疗效良好, 104 例 (56.5%) 患者疗效良好, 5 例患者 (2.7%) 结果合理。复发 (包括早和晚) 在190个水平被看见了15在操作了在 (7.89%)。本文提出了一种新颖的外入方法, 它依赖于在孔内的精确着陆, 以移动的方式, 不完全取决于扩大的孔。它在应用上更具通用性, 在处理各种椎间盘脱垂方面也有用处, 即使在严重的运河折衷和高迁徙中也是如此。
Introduction
fChronic 腰痛和腿部疼痛是任何社会中常见的疾病。治疗退行性腰椎间盘疾病的方法不断发展。医疗设备已经广泛, 从开放性手术和固定到 microlumbar 椎间盘摘除术, 现在的内窥镜路线1,2,3,4。最初由 Parvez Kambin 建议的经神经孔通路, 现在逐渐成为护理标准5,6,7。全内镜脊柱手术的优点是减少软组织解剖, 减少失血, 缩短入院天数, 早期功能恢复, 提高生活质量8。
舒伯特和 Hoogland4所给出的传统的 PETLD 方法, 涉及在孔中引入工作套管, 然后使用铰刀将孔扩大。这里所提到的外来方法的新技术背后的基本原理是, 它并不完全取决于在所有情况下扩大孔。该技术的重点是在孔内的工作套管的精确放置, 然后引导套管的运动向目标片段, 在内窥镜视野9,10。解剖上, 有三条不同的路线进入经神经孔空间, 如果有效使用, 经皮内窥镜脊柱手术与外技术可应用于更广泛的腰椎间盘突出症。中央、paracentral、高管受损的乳酸脱氢酶 (LDH) 由椎间隙通路接触;椎间孔、优迁移和远侧 ldh 由椎间孔路线接近, 相接迁移的 ldh 由 suprapedicular 路线6接近。这项技术的优点是它保留了正常的解剖结构, 盘损伤较小, 硬膜外暴露是容易的, 并操作套管在孔不难。所描述的技术与前面的方法不同, 因为它提供了孔内结构的精确视觉, 重点放在孔内套管的准确放置, 而不是扩大孔。该技术同样安全, 作为内出技术, 并提供了一个简单的处理结构, 特别是挤压碎片。本研究的目的是证明这一新方法的通用性, 以管理不同类型的椎间盘脱垂为中心, paracentral, 椎间孔, 远侧, 上下迁移, 以及在高渠道妥协的情况下。然而, 这项技术需要更长的学习曲线, 所以初学者在学习时要有耐心。
Protocol
Representative Results
Discussion
本研究基于对我院184例腰椎间盘疾病患者的前瞻性分析。在所有病例中都进行 X 线成像、计算机断层扫描 (CT) 和磁共振成像 (MRI), 以确认诊断和排除其他病理。CT 和 MRI 扫描显示的结果与神经系统检查相关。正确诊断后, 患者在 PETLD 的移动外技术上进行手术。排除标准是出现节段不稳定, 超过1级的腰椎滑脱, 以及存在明显的脊柱狭窄。所有患者均获得书面知情同意。
上述技术?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
我们要感谢科学团队成员京和金银在获取全文文章和管理数字作品方面提供帮助。
Materials
| Contrast dye injection | Iobrix injection, Taejoon pharm,Seoul, Korea | S.No. 1 | |
| 0.8% indigo carmine | Carmine, Korea United Pharmaceutical, Yoenki, Korea | S.No. 2 | |
| 30 degree endoscope | Joimax GmbH, Germany | S.No. 3 | |
| Radiofrequency coagulator | Elliquence, New York, USA | S.No. 4 | |
| Drill | Primado 2 NSK, Tochigi, Japan | S.No. 5 |
Riferimenti
- Tzaan, W. Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung medical journal. 30 (3), 226 (2007).
- Morgenstern, R., Morgenstern, C. Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results. International journal of spine surgery. 9, (2015).
- Ying, J., et al. The effect and feasibility study of transforaminal percutaneous endoscopic lumbar discectomy via superior border of inferior pedicle approach for down-migrated intracanal disc herniations. Medicina. 95 (8), (2016).
- Schubert, M., Hoogland, T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Operative Orthopadie und Traumat.ologie. 17 (6), 641-661 (2005).
- Telfeian, A. E., Jasper, G. P., Francisco, G. M. Transforaminal endoscopic treatment of lumbar radiculopathy after instrumented lumbar spine fusion. PainPhysician. 18 (2), 179-184 (2015).
- Kim, H. S., et al. Analysis of clinical results of three different routes of percutaneous endoscopic transforaminal lumbar discectomy for lumbar herniated disk. Worldneurosurgery. 103, 442-448 (2017).
- Gore, S., Yeung, A. The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. International journal of spine surgery. 8, (2014).
- Choi, G., Pophale, C. S., Patel, B., Uniyal, P. Endoscopic Spine Surgery. Journal of Korean Neurosurgical Society. 60 (5), 485 (2017).
- Hoogland, T., Schubert, M., Miklitz, B., Ramirez, A. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine. 31 (24), E890-E897 (2006).
- Ruetten, S., Komp, M., Godolias, G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine. 30 (22), 2570-2578 (2005).
- Johnson, E. W. . Visual analog scale (VAS). , (2001).
- Fairbank, J. Oswestry disability index. Journal of neurosurgery Spine. 20 (2), 239 (2014).
- Macnab, I. Negative Disc Exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. The Journal of bone and joint surgery. 53 (5), 891-903 (1971).
- Hoogland, T., van den Brekel-Dijkstra, K., Schubert, M., Miklitz, B. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine. 33 (9), 973-978 (2008).
- Yeung, A. T., Tsou, P. M. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 27 (7), 722-731 (2002).
- Kambin, P., Gellman, H. Percutaneous Lateral Discectomy of the Lumbar Spine A Preliminary Report. Clinical Orthopaedics and Related Research. 174, 127-132 (1983).
- Hoogland, T. Percutaneous endoscopic discectomy. Journal of neurosurgery. 79 (6), 967-968 (1993).
- Knight, M., Goswami, A. Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression. Spine. 28 (6), 573-581 (2003).
- Pain, B., Telfeian, A. E. A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients. Painphysician. 16, 225-229 (2013).
- Kim, H. S., Ju, C. I., Kim, S. W., Kim, J. G. Endoscopic transforaminal suprapedicular approach in high grade inferior migrated lumbar disc herniation. Journal of Korean Neurosurgical Society. 45 (2), 67 (2009).
- Chae, K. H., et al. Strategies for noncontained lumbar disc herniation by an endoscopic approach: transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction CT with discogram. Journal of Korean Neurosurgical Society. 46 (4), 312 (2009).
- Anichini, G., et al. Lumbar endoscopic microdiscectomy: Where are we now? An updated literature review focused on clinical outcome, complications, and rate of recurrence. BioMed research international. , (2015).
- Gotecha, S., et al. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations. Journal of craniovertebral junction & spine. 7 (4), 217 (2016).
- Ruetten, S., Komp, M., Merk, H., Godolias, G. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. Clinical Spine Surgery. 22 (2), 122-129 (2009).
- Weir, B., Jacobs, G. Reoperation rate following lumbar discectomy. An analysis of 662 lumbar discectomies. Spine. 5 (4), 366-370 (1980).
- Österman, H., Sund, R., Seitsalo, S., Keskimäki, I. Risk of multiple reoperations after lumbar discectomy: a population-based study. Spine. 28 (6), 621-627 (2003).
- Xin, G., Shi-Sheng, H., Hai-Long, Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy. Clinical Anatomy. 26 (6), 728-734 (2013).
- Pan, Z., Ha, Y., Yi, S., Cao, K. Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation. Medical science monitor: international medical journal of experimental and clinical research. 22, 530 (2016).
