摘要
目的探讨椎间盘造影术在经皮腰椎间孔镜手术中的作用。方法 2009年11月～2011年6月间共收治腰椎退行性疾病患者218名,诊断为腰椎间盘突出症(lumbar disc herniation,LDH)130例;诊断为腰椎管狭窄88例;2例为术后感染再次行椎间孔镜手术予以处理。既往有开放手术内固定史12例;合并退变性脊柱侧弯6例。经制定穿刺麻醉计划,在手术室C臂X线机透视定位辅助下行240例椎间盘造影试验。结果共作椎间盘造影240次,其中168次(70%)造影前诊断为病变椎间盘作诱发试验结果阳性(有20个病人两个椎间盘阳性);27次(11.2%)拟作为阴性对照的椎间盘诱发试验结果阳性。43次(18%)临床表现或影像学有阳性表现,但椎间盘诱发试验结果阴性,其中12次(5%)造影见纤维环破裂、造影剂外溢。2例(0.8%)腰椎间孔镜手术后感染者未作加压诱发试验,仅注射少量造影剂定位。判断为阳性椎间盘时造影剂的用量为0.1～3.5(1.7±0.8)ml。被诱发的疼痛常为腰痛、患侧臀部、股部、小腿或足部疼痛,偶有腹部疼痛。疼痛性质、部位与术前相似率达85%。造影后疼痛加重,但经其进一步明确病情后的腰椎间孔镜手术治疗如髓核射频消融减压或摘除、纤维环成形、骨赘黄韧带、碎片等清除后一般能使症状明显减轻,残余症状用药物等容易控制,一般在48h内消失。造影过程中所有病人均未发生明显的出血。2例其造影示椎体前缘有造影剂泄露,在诱发试验后诉以前曾有的腹部不适加重,经卧床休息数小时后自然缓解。2例术后发生感染经综合治疗后得以控制。结论经皮腰椎间孔镜手术将椎间盘造影术融合为一个步骤,能进一步明确腰部疾病的本质,有助于这一微创手术的顺利进行并提高CLBP尤其是盘源性疾病诊断和治疗水平。但是,其中某些细节仍需改进,并应对此设计大样本的随机、多中心、对照的临床研究深入探讨。
Objective To investigate the function of discography in percutaneous transforaminal endoscopic surgery（PTES）. Meth- ods There were 218 degenerative lumbar disease patients admitted from Nov. 2009 to Jun. 2011 among which 130 cases were diagnosed lumbar disc herniation; 88 lumbar spinal stenosis;2 reoperated for postoperative intradiscal infection due to previous PTES. Comorbiditymainly included 6 degenerative thoracic and/or lumbar scoliosis and 12 previous open lumbar surgery with implants. Following preopera- tive formulation of orientated puncture and anesthetic strategy, discography was performed under C - arm X - ray guidance in the operating theater as an integral procedure of PTES. Results Discography was implemented 240 times among which 70% preoperatively judged sick discs were confirmed positive by provocative discography 20 patients had double positive discs,and 11.2% control discs were provocated positive. Discography were negative 43 times（18% ） despite positive clinical features and in 12 of them （5%） annular rupture and contrast leakage were observed. Low pressure contrast media injection had been given only for determining location of discs in 2 post - PTES intradiscal infection patients instead of provocative discography. Injection volume of contrast media when confirmed positive was 0.1 - 3.5 （1.7 ± 0.8）ml. Provocated pain was usually at the back, buttock, lower extremity and occasionally（2 cases） in abdomen. Pain quality was similar to that before procedure in 85% cases. Aggravated pain by discography was usually relieved by subsequent PTES including ra- diofrequency ablation or removal of pulposus nucleus, annuloplasty, fragmentectomy, osteophyteetomy,and so on. Residual pain usually disappeared in 48 hours or easily controlled by pain medication. No bleeding occurred. Contrast media leaked to anterior border of the ver- tebra was observed in two patients who complained preexisting abdominal discomfort aggravated but gradually relieved by simple bed rest for several hours.
出处
《医学研究杂志》
2012年第9期155-159,共5页
Journal of Medical Research
关键词
腰痛椎间盘造影术微创椎间孔镜经皮
Discography
Back pain
Minimally invasive
Transforaminal
Endoscopy
