PERCUTANEOUS ENDOSCOPIC DISCECTOMY - SURGICAL TECHNIQUE AND PRELIMINARY-RESULTS COMPARED TO MICROSURGICAL DISCECTOMY
PERCUTANEOUS ENDOSCOPIC DISCECTOMY - SURGICAL TECHNIQUE AND PRELIMINARY-RESULTS COMPARED TO MICROSURGICAL DISCECTOMY
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DOI：
10.3171/jns.1993.78.2.0216
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发表时间：
1993-02-01
影响因子：
4.1
通讯作者：
BROCK, M
中科院分区：
文献类型：
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作者：
MAYER, HM;BROCK, M
经皮内窥镜椎间盘切除术是一种新技术，用于清除“包容性”腰椎间盘突出症（纤维环外缘完整）和小的“非包容性”腰椎间盘突出症（位于椎间盘间隙水平，占椎管矢状直径小于三分之一），通过后外侧入路，借助专门开发的器械。该技术结合了刚性直，角度和灵活的镊子与自动化大功率吸力剃须刀和刀具系统。因此可以进入椎间盘突出的椎间隙的背侧。经皮内窥镜椎间盘切除术使用角度为70度的内窥镜配合电视和录像装置进行监测，患者在局部麻醉下进行，必要时可由麻醉师陪同。它的适应症仅限于椎间盘源性根受压伴轻微神经功能障碍。采用经皮内镜下椎间盘切除术（20例）和显微椎间盘切除术（20例）治疗封闭式或小型非封闭式椎间盘突出。为了比较两种方法的疗效，我们对两组患者进行了前瞻性随机研究。椎间盘突出位于L2-3（1例）、L3-4（2例）或L4-5（37例）。两组患者在年龄、性别分布、术前主诉演变、既往保守治疗、患者职业、术前残疾、临床症状等方面无显著差异。经皮内窥镜椎间盘切除术两年后，坐骨神经痛80%（16 / 20）消失，腰痛47%(9 / 19)，感觉缺陷92.3%(12 / 13)，运动缺陷1例。微椎间盘切除术两年后，65%（13 / 20）的坐骨神经痛消失，25%（5 / 20）的腰痛消失，68.8%（11 / 16）的感觉缺陷消失，所有受此影响的患者都有运动缺陷。显微椎间盘切除术组只有72.2%的患者恢复了原来的职业，而经皮内镜椎间盘切除术组为95%。经皮内窥镜椎间盘切除术似乎为“包含”和小的韧带下腰椎间盘突出症患者提供了一种替代显微椎间盘切除术的方法。
Percutaneous endoscopic discectomy is a new technique for removing ''contained'' lumbar disc herniations (those in which the outer border of the anulus fibrosus is intact) and small ''noncontained'' lumbar disc herniations (those at the level of the disc space and occupying less than one-third of the sagittal diameter of the spinal canal) through a posterolateral approach with the aid of specially developed instruments. The technique combines rigid straight, angled, and flexible forceps with automated high-power suction shaver and cutter systems. Access can thus be gained to the dorsal parts of the intervertebral space where the disc herniation is located. Percutaneous endoscopic discectomy is monitored using an endoscope angled to 70-degrees coupled with a television and video unit and is performed with the patient under local anesthesia and an anesthesiologist available if needed. Its indication is restricted to discogenic root compression with a minor neurological deficit.Two groups of patients with contained or small noncontained disc herniations were treated by either percutaneous endoscopic discectomy (20 cases) or microdiscectomy (20 cases). Both groups were investigated in a prospective randomized study in order to compare the efficacy of the two methods. The disc herniations were located at L2-3 (one patient), L3-4 (two patients), or L4-5 (37 patients). There were no significant differences between the two groups concerning age and sex distribution, preoperative evolution of complaints, prior conservative therapy, patient's occupation, preoperative disability, and clinical symptomatology. Two years after percutaneous endoscopic discectomy, sciatica had disappeared in 80% (16 of 20 patients), low-back pain in 47% (nine of 19 patients), sensory deficits in 92.3% (12 of 13 patients), and motor deficits in the one patient affected. Two years after microdiscectomy, sciatica had disappeared in 65% (13 of 20 patients), low-back pain in 25% (five of 20 patients), sensory deficits in 68.8% (11 of 16 patients), and motor deficits in all patients so affected. Only 72.2% of the patients in the microdiscectomy group had returned to their previous occupation versus 95% in the percutaneous endoscopic discectomy group. Percutaneous endoscopic discectomy appears to offer an alternative to microdiscectomy for patients with ''contained'' and small subligamentous lumbar disc herniations.