Wang Dong, Pan Hao, Hu Qinfeng, Zhu Hang, Zhu Li, He Yongjiang, Wang Jian, Jia Gaoyong
Department of Orthopaedics, The Affiliated Guang-Xing Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China.
Asian J Endosc Surg. 2017 Feb;10(1):87-91. doi: 10.1111/ases.12320.
Although endoscopic procedures for lumbar disc diseases have improved greatly, treating migrated disc herniation is still a challenging task. Because of anatomic limitations, a rigid endoscope cannot effectively reach the herniated nucleus pulposus (HNP) in the hidden zone. The purpose of this study was to describe the transpedicle approach for HNP in the hidden zone using the percutaneous endoscopic lumbar discectomy system and to demonstrate the clinical results. Materials and Surgical Technique: Under fluoroscopy, the percutaneous endoscopic lumbar discectomy cannula is placed on the superior articular process, and a trephine with a diameter of 7.3 mm is used to make a bone hole. Through the bone hole, an HNP in the hidden zone can be detected with a rongeur for percutaneous endoscopic lumbar discectomy, the HNP can be removed, and then the decompressed nerve root is verified. We have treated two cases of hidden-zone HNP using the transpedicle approach. In all cases, the HNP was successfully removed, as confirmed by postoperative MRI. Clinical outcomes were acceptable.
The percutaneous endoscopic transpedicle approach is an effective technique for managing HNP in the lumbar hidden zone.
尽管用于腰椎间盘疾病的内镜手术已取得了很大进展，但治疗游离型椎间盘突出症仍是一项具有挑战性的任务。由于解剖学限制，硬性内镜无法有效到达隐匿区的突出髓核（HNP）。本研究的目的是描述使用经皮内镜腰椎间盘切除术系统治疗隐匿区HNP的经椎弓根入路，并展示临床结果。材料与手术技术：在荧光透视引导下，将经皮内镜腰椎间盘切除术套管置于上关节突，使用直径7.3毫米的环锯制作骨孔。通过该骨孔，可用经皮内镜腰椎间盘切除术咬骨钳探测隐匿区的HNP，切除HNP，然后确认神经根减压情况。我们已使用经椎弓根入路治疗了2例隐匿区HNP患者。所有病例中，术后MRI证实HNP均成功切除。临床结果可接受。
经皮内镜经椎弓根入路是治疗腰椎隐匿区HNP的有效技术。
