经皮内镜下腰椎间孔入路治疗高度移位型椎间盘突出症的手术疗效
Surgical Outcome of Percutaneous Endoscopic Interlaminar Lumbar Discectomy for Highly Migrated Disk Herniation.
作者信息
Kim Chi H, Chung Chun K, Woo Ji W
机构信息
*Department of Neurosurgery, Seoul National University College of Medicine†Neuroscience Research Institute, Seoul National University Medical Research Center‡Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
出版信息
Clin Spine Surg. 2016 Jun;29(5):E259-66. doi: 10.1097/BSD.0b013e31827649ea.
STUDY DESIGN
Technical report.
OBJECTIVE
To present a detailed surgical technique for percutaneous endoscopic interlaminar discectomy (PEID) for highly migrated disk herniation.
SUMMARY OF BACKGROUND DATA
Percutaneous lumbar endoscopic discectomy for highly migrated disk herniation is still challenging even for an experienced surgeon. Because of the risk of failure and technical difficulty, open discectomy is recommended for a high-grade migration. However, past reports focused on the transforaminal approach (percutaneous endoscopic transforaminal discectomy) and may give a biased impression. We may overlook the merit of PEID. The surgical procedure for PEID is similar to a traditional open discectomy and the range of approach could be widened by the inclined introduction and pivoting motion of an endoscope.
METHODS
Eighteen consecutive patients (M:F=12:6; age, 56±15 y) with highly migrated disk herniation were enrolled for the present study. The disk material was migrated superiorly in 7 patients (L4-5, 4; L5-S1, 2; L2-3, 1) and inferiorly in 11 patients (L4-5, 6; L3-4, 4; L5-S1, 1). PEID was applied in 17 patients and PETD was performed for L2-3 disk herniation. The follow-up period was 16±12 months. The outcome was graded using the MacNab criteria.
RESULTS
Complete removal of the disk material was confirmed with magnetic resonance imaging in 16 patients (success rate 89%). Revision operation was necessary in 2 patients with inferior migration from L4-5. The residual disk was removed through the L5-S1 laminar window 2 days after surgery with excellent outcome at the last follow-up. The outcome at the last follow-up was excellent in 12 patients, good in 3, fair in 2, and poor in 1. Dural tear was suspected in 1 patient without any further problems and there was no recurrence during follow-up.
CONCLUSIONS
PEID may be applied comfortably even for less-experienced surgeons because of the familiar anatomy with open surgery.
研究设计
技术报告。
目的
介绍用于高度移位椎间盘突出症的经皮内镜椎间孔间椎间盘切除术（PEID）的详细手术技术。
背景数据总结
即使对于经验丰富的外科医生，经皮腰椎内镜下治疗高度移位椎间盘突出症仍具有挑战性。由于存在失败风险和技术难度，对于高度移位的情况，建议行开放性椎间盘切除术。然而，既往报告主要集中在经椎间孔入路（经皮内镜下经椎间孔椎间盘切除术），可能会给人造成有偏差的印象。我们可能忽略了PEID的优点。PEID的手术操作类似于传统开放性椎间盘切除术，并且通过内镜的倾斜置入和旋转动作可以扩大手术入路范围。
方法
本研究纳入18例连续的高度移位椎间盘突出症患者（男∶女 = 12∶6；年龄，56±15岁）。7例患者椎间盘组织向上移位（L4 - 5，4例；L5 - S1，2例；L2 - 3，1例），11例患者向下移位（L4 - 5，6例；L3 - 4，4例；L5 - S1，1例）。17例患者采用PEID治疗，L2 - 3椎间盘突出症患者行PETD。随访时间为16±12个月。采用MacNab标准对结果进行分级。
结果
16例患者经磁共振成像证实椎间盘组织完全切除（成功率89%）。2例L4 - 5向下移位患者需要进行翻修手术。术后2天通过L5 - S1椎板窗口切除残留椎间盘，末次随访时效果良好。末次随访时，12例患者效果优，3例良好，2例一般，1例差。1例患者怀疑有硬脊膜撕裂，但无进一步问题，随访期间无复发。
结论
由于与开放手术的解剖结构相似，即使是经验不足的外科医生也可以舒适地应用PEID。
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