自制自攻环锯在可视化椎间孔镜治疗腰椎间盘突出症中的应用价值

目的:探讨用自制自攻环锯行可视下椎间孔扩大成形术在椎间孔镜治疗腰椎间盘突出症中的价值。方法:选择2016年1月至2018年12月使用椎间孔镜技术治疗腰4/5、腰5/骶1椎间盘突出症患者64例,其中术中使用普通环锯与自制自攻环锯行椎间孔扩大成形术各32例。分别记录患者椎间孔扩大成形时间、术中透视次数、住院天数、术后相关并发症;对比术前、术后1 d、术后6个月患者的腰腿痛视觉模拟评分(visual analogue scale,VAS)与Oswestry功能障碍指数(Oswestry disability index,ODI);术后6个月采用改良Macnab法进行疗效评价。结果:自制环锯组椎间孔扩大成形时间、手术时间、术中透视次数少于普通环锯组,差异有统计学意义(P<0.05);两组患者住院天数差异无统计学意义。两组患者术中均无腹腔脏器与大血管破裂发生,无复发。普通环锯组、自制环锯组组内患者腰腿疼痛术前VAS与术后1 d、术后6个月评分差异有统计学意义(P<0.05),术前ODI评分与术后1 d、术后6个月评分差异有统计学意义(P<0.05);普通环锯组与自制环锯组患者组间各时间点VAS、ODI评分差异无统计学意义。普通环锯组术后6个月疗效优良率与自制环锯组患者差异无统计学意义93.8%(30/32)vs 96.9%(31/32)]。结论:自制自攻环锯在可视下椎间孔镜治疗腰椎间盘突出症中的应用安全有效,具有置管步骤简便、直视下进行椎间孔扩大成形、透视次数少的优点。

Application of customized self tapping trephine in endoscopic surgery for lumbar disc herniation

Objective: To explore the application value of the customized self tapping trephine in the treatment of lumbar disc herniation by intervertebral foramen enlargement. Methods: Totally, 64 cases of L_4/5 and L₅/S₁ disc herniation were treated from January 2016 to December 2018. There were 32 cases of enlarged intervertebral foramen formed by ordinary trephine and customized self tapping trephine during operation, respectively. The time of enlargement of the intervertebral foramen, the number of intraoperative fluoroscopy, the days of hospitalization, and the postoperative complications were recorded. The visual analogue scale (VAS) of lumbar and leg pain and Oswestry disability index (ODI) were recorded before and 1 day and 6 months after the operation, and the modified Macnab method was used to evaluate the curative effect 6 months after the operation. Results: There were statistically significant differences in the time of the enlargement of the intervertebral foramen, the operation time, and the frequency of intraoperative fluoroscopy between the two groups. There was no difference in the days of hospitalization between the two groups. There was no abdominal organs and large vascular rupture complications during surgery in the two groups. The differences of VAS between preoperative and 1 day and 6 months after the operation were statistically significant within groups (P<0.05). The differences of ODI between preoperative and 1 day after the operation and 6 months after operation were significant within groups (P<0.05). While there was no significant difference in VAS and ODI at different time points between the two groups (P<0.05). There was no significant difference in the excellent and good rate 6 months after the operation between the two groups (93.8% vs 96.9%). Conclusions: The customized self tapping trephine intervertebral foramen forming method is safe and effective in the treatment of lumbar intervertebral disc herniation. This method has the advantages of simple procedure of intubation, expansion of the intervertebral foramen under direct vision, and less frequency of fluoroscopy.