1切2中垂直内移测量法在高位腰椎间盘突出症经皮椎间孔镜侧路手术治疗中的应用

目的 探讨1切2中垂直内移测量法在经皮椎间孔镜侧路手术治疗高位腰椎间盘突出症(L_1/2或L_2/3)的安全性及初步疗效分析。方法 纳入山西省人民医院骨科2017年6月—2018年8月单节段高位腰椎间盘突出症的患者20例进行回顾性分析,其中男13例、女7例,年龄55～84岁、平均65.14岁;病变节段位于L_1/2者8例,L_2/3者12例。术前均采用1切2中垂直内移测量法在MRI横断面测量后,确定穿刺旁开距离和穿刺点;手术均采用经皮椎间孔镜经椎间孔入路全内镜下逐步扩大椎间孔,直视下进行神经减压。分析手术时间,术前、术后3个月、6个月分别采用VAS、ODI对患者临床表现及功能情况进行评估,总体临床疗效的评价采用MacNab评估标准。结果 20例患者手术均顺利,无输尿管和肾脏损伤及其他并发症。手术时间(72.13±23.01)min;术后伤口均愈合良好,术后第2天均佩戴腰围下地活动、适当功能锻炼,术后第3天出院。术后均获得6个月以上的随访。根据MacNab评估标准,术后疗效优14例(70%)、良5例(25%)、可1例(5%),优良率为95%。术前、术后3个月、术后6个月,VAS分别为(65.15±7.16)分、(22.02±9.64)分和(10.13±9.61)分,ODI分别为45.17%±10.54%、16.51%±8.35%和11.65%±5.93%,术后3、6个月分别与术前比较,差异均有统计学意义(P值均＜0.01)。结论 在高位腰椎间盘突出症经皮椎间孔镜侧路手术治疗中,采用1切2中垂直內移测量法定位穿刺旁开距离和穿刺点安全可靠,可以达到较好的临床效果。

The application of 1 tangent line 2 midpoint vertical shift measurement method in the treatment of upper lumbar intervertebral disc herniation by percutaneous transforminal endoscopic discectomy

Objective To evaluate the clinical effect and security of upper lumbar intervertebral disc herniation by endoscopic transforaminal decompression with 1 tangent line 2 midpoint vertical shift measurement method.Methods From June 2017 to August 2018,20 orthopedic patients from Shanxi Province People's Hospital met single segment of upper lumbar disc herniation(L1/2 or L2/3)were included in the study with retrospective analysis.There were 13 males and 7 females,aged from 55 to 84 years,average 65.14 years.These patients underwent surgery using endoscopic transforaminal decompression.All surgeries were performed under full endoscope and nerve decompression was performed under direct vision to avoid the risk of nerve injury caused by direct puncture and catheterization.The 1 tangent line 2 midpoint vertical shift measurement method was used to determine the bypass distance and puncture point on MRI transection.Average operative was analyzed.The clinical symptoms of the included patients were evaluated by VAS and ODI c at 3 and 6 months after surgery,and the overall clinical efficacy was evaluated by the MacNab score.Results All the 20 patients had good wound healing after surgery,no ureter and kidney injury and other complications,and recovered well.On the second day,they all wore waist activities,performed proper functional exercise,and were discharged from the hospital 3 days after surgery.Average operative time was(72.13±23.01)min.The Mac Nab scores were excellent in 14 cases(70%),good in 5 cases(25%),generally good in 1 case(5%).The overall optimal rate was 95%.Pre-op VAS was 65.15±7.16,ODI was 45.17%±10.54%.Post-op 3 months VAS was 22.02±9.64,ODI was 16.51%±8.35%.Post-op 6 VAS was 10.13±9.61,ODI was 11.65%±5.93%.The VAS and ODI were significantly improved compared with the preoperative values,and these differences were statistically significant(all P values<0.01).Conclusions In the treatment of upper lumbar intervertebral disc herniation by percutaneous transforaminal endoscopic discectomy,the 1 tangent line 2 midpoint vertical shift measurement method is safe and reliable to locate the bypass distance and puncture point,which can achieve a better clinical effect.