Kambin P, Sampson S
Clin Orthop Relat Res. 1986 Jun(207):37-43.
Fifty consecutive patients with intractable sciatic pain, positive root tension signs, correlative myelography, and neurological impairment were treated by percutaneous lateral discectomy (PLD). Under local anesthesia and C-arm fluoroscopy control, an 18-gauge needle, introduced into the intervertebral disc dorsolaterally, entered the skin at approximately 9 cm from the midline. A Kirschner wire replaced the stylet of the needle, and the needle was withdrawn. The introduction of a specially designed cannulated trocar over the K-wire facilitated precisional insertion of the instruments. This step was followed by the introduction of a sheath with an internal diameter of 4.9 mm over the trocar. The sheath was held against the annulus fibrosis, and the cannulated trocar was removed. The annulus was windowed and the herniated disc material evacuated by instruments and suction. Evaluations were made with Macnab's criteria. Excellent and good results were obtained in 88% of patients. The mean length of hospital stay after operation was 2.3 days. The operative time, blood loss, and morbidity were minimal, and no serious complications were encountered. In carefully selected patients, PLD appears to be safe, effective, and cost-efficient.
对50例患有顽固性坐骨神经痛、神经根牵拉征阳性、相关脊髓造影检查阳性及神经功能障碍的连续患者进行了经皮侧方椎间盘切除术（PLD）。在局部麻醉和C型臂荧光透视控制下，将一根18号针经背外侧插入椎间盘，进针点位于距中线约9 cm处的皮肤。用一根克氏针替换针芯，然后拔出针。在克氏针上插入一根特制的空心套管针，便于精确插入器械。此步骤之后，在套管针上套入一根内径为4.9 mm的鞘管。将鞘管抵住纤维环，拔出空心套管针。在纤维环上开窗，用器械和吸引器清除突出的椎间盘组织。采用Macnab标准进行评估。88%的患者获得了优或良的结果。术后平均住院时间为2.3天。手术时间、失血量和发病率极低，未出现严重并发症。在经过精心挑选的患者中，经皮侧方椎间盘切除术似乎安全、有效且具有成本效益。
