导杆漂移技术穿刺置管在PTED治疗L5/S1椎间盘突出症中的应用

目的 探讨导杆漂移技术穿刺置管在经皮椎间孔镜下椎间盘切除术（PTED）治疗L5/S1椎间盘突出症中的安全性和有效性。方法 回顾性分析2019年1月～2020年12月采用导杆漂移技术辅助PTED治疗的34例L5/S1椎间盘突出症的临床资料。术前、术后1个月、3个月、末次随访时，采用疼痛视觉模拟量表（VAS）评分评估病人腰部、腿部疼痛程度，采用Oswestry功能障碍指数（ODI）评估病人功能恢复情况。末次随访时，采用改良Macnab分级标准评定优良率。结果 均顺利完成手术，透视次数为（12.65±4.51）次；通道建立时间为（24.06±4.07）min；手术时间为（63.82±8.96）min。随访时间为14～30个月，平均（20.09±4.29）个月。术后腰痛、腿痛VAS评分及ODI评分均明显降低（P<0.05）。末次随访时，根据改良MacNab标准：优24例，良8例，可2例；优良率为94.12%。结论 应用PTED治疗L5/S1椎间盘突出症，经皮椎间孔镜导杆漂移技术能安全、有效地置管，降低穿刺难度，提高手术安全性，手术效果良好。

Application of working channel placement assissted by guide-rod drift technique to percutaneous transforminal endoscopic discectomy for patients with L5/S1 disc herniation

Objective To explore the safety and effectiveness of working channel placement assissted by guide-rod drift technique during percutaneous transforminal endoscopic discectomy (PTED) for the patients with L5/S1 disc herniation (L5/S1 DH). Methods A retrospective analysis was performed on the clinical data of 34 patients with L5/S1 DH treated with PTED from January 2019 to December 2020. During the operation, the working channel was placed by guide-rod drift technique. The visual analogue scale (VAS) was used to evaluated the low back and leg pain, the Oswestry disability index (ODI) was used to evaluate the neurological function,and the modified MacNab criteria was used to evaluated the efficacy. Results All the patients successfully completed the procedure. The mean number of fluoroscopy was (12.65±4.51) times, the mean time of channe establishment was (24.06±4.07) minutes, and the mean operation time was (63.82±8.96) minutes. The follow-up time ranged from 14 months to 30 months, with a mean time of (20.09±4.29) months. The VAS and ODI scores were significantly reduced after operation (P<0.05). At the last follow-up, excellent outcomes were achieved in 24 patients, good in 8, and fair in 2 according to the modified MacNab criteria. The rate of excellent and good outcomes was 94.12%. Conclusions For the patients with L5/S1 DH undergoing PTED, working channel placement assissted by guide-rod drift technique is safe and effective, which can reduce the difficulty of puncture, improve the safety of the operation, and obtain good outcomes.