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中华神经创伤外科电子杂志 ›› 2024, Vol. 10 ›› Issue (04) : 243 -247. doi: 10.3877/cma.j.issn.2095-9141.2024.04.009

经验交流

3D数字外视显微镜下微通道手术治疗腰椎间盘突出的疗效分析
赵晓秋1, 李锋2, 赵传东2, 刘元钦2, 林彦达2, 辛涛2,†()   
  1. 1.261053 山东潍坊，山东第二医科大学临床医学院
    2.250014 济南，山东第一医科大学第一附属医院神经外科
  • 收稿日期:2024-04-26 出版日期:2024-08-15
  • 通信作者: 辛涛
  • 基金资助:
    山东省自然科学基金重大基础研究项目（ZR2022ZD20）济南市临床科技创新计划项目（202019137）

Analysis of the curative effect of microchannel surgery on lumbar disc herniation under three-dimensional robotic digital microscope

Xiaoqiu Zhao1, Feng Li2, Chuandong Zhao2, Yuanqin Liu2, Yanda Lin2, Tao Xin2,†()   

  1. 1.College of Clinical Medicine, Shandong Second Medical University, Weifang 261053,China
    2.Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University,Ji'nan 250014,China
  • Received:2024-04-26 Published:2024-08-15
  • Corresponding author: Tao Xin
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赵晓秋, 李锋, 赵传东, 刘元钦, 林彦达, 辛涛. 3D数字外视显微镜下微通道手术治疗腰椎间盘突出的疗效分析[J]. 中华神经创伤外科电子杂志, 2024, 10(04): 243-247.

Xiaoqiu Zhao, Feng Li, Chuandong Zhao, Yuanqin Liu, Yanda Lin, Tao Xin. Analysis of the curative effect of microchannel surgery on lumbar disc herniation under three-dimensional robotic digital microscope[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(04): 243-247.

目的

探讨3D 数字外视显微镜下微通道手术治疗腰椎间盘突出（LDH）的临床疗效。

方法

回顾性分析山东第一医科大学第一附属医院神经外科自2023年6～8月收治的5例LDH患者的临床资料。5 例患者均行3D 数字外视显微镜下微通道手术，术后2 周采用视觉模拟量表（VAS）评估疼痛缓解程度；通过腰椎CT 及三维重建评估脊柱稳定及小关节的损伤情况；术后6个月采用改良MacNab 评分评估手术疗效。

结果

5 例患者均顺利完成手术，手术时长（68.00±7.11）min，术中失血量（22.00±3.10）mL。术后5例患者的腰痛、下肢麻木、感觉减退等症状均明显好转；术后2 周VAS 评分（2.20±0.40）分；术后1 个月复查腰椎CT 及三维重建显示小关节及关节突保护良好；术后6 个月改良MacNab 评分优良率100%，其中4 例优、1 例良；随访6 个月均无复发性腰痛、腰椎不稳定等并发症。

结论

3D 数字外视显微镜下微通道手术是治疗LDH 安全、有效的手术方案，短中期随访可观察到良好疗效。

关键词: 腰椎间盘突出, 微通道, 3D数字外视显微镜

Objective

To investigate the surgical technique and clinical effect of three -dimensional (3D) robotic digital microscope microchannel surgery for lumbar disc herniation (LDH).

Methods

The clinical data of 5 patients with LDH admitted to Neurosurgery Department of the First Affiliated Hospital of Shandong First Medical University from June to August 2023 were retrospectively analyzed. All 5 patients underwent 3D robotic digital microscope microchannel surgery. The degree of pain relief was evaluated by visual analogue scale (VAS) score 2 weeks after surgery. Spinal stability and facet joint injury were assessed by CT and 3D reconstruction of the lumbar spine. MacNab score was modified to evaluate the clinical effect 6 months after surgery.

Results

All 5 cases successfully completed the surgery, with the operation time of (68.00±7.11) min, and the intraoperative blood loss of(22.00±3.10) mL. After surgery, the symptoms of lumbago, lower limb numbness, hypoesthesia and other symptoms of 5 patients were significantly improved. The VAS score was 2.20±0.40 2 weeks after surgery;CT three-dimensional reconstruction of lumbar spine 1 month after surgery showed that facet joints and facet processes were well protected.The excellent and good rate of the modified MacNab score was 100%6 months after surgery, with with 4 cases being excellent and 1 case being good. None of the 5 patients had recurrent low back pain,lumbar instability and other complications.

Conclusion

3D robotic digital microscope microchannel surgery is a safe and effective procedure for the treatment of LDH, and good curative effect can be observed in short and medium follow-up.

Key words: Lumbar disc herniation, Microchannel, Three-dimensional robotic digital microscope
图1 3D数字外视显微镜下微通道手术治疗腰椎间盘突出的示意图 A：3D 数字外视显微镜下微通道手术置入微通道的示意图；B：术中使用微通道扩张器建立微通道；C：腰椎CT 三维重建示意图：微通道放置于相应椎板外侧峡部表面（红色圆圈）
Fig.1 Schematic diagram of microchannel surgery for lumbar disc herniation under three-dimensional robotic digital microscope
图2 L5～S1椎间隙椎间盘突出患者治疗前、后影像学资料 A：术前腰椎MRI示L5～S1平面椎间孔外椎间盘挤压神经根（箭头所示）；B：术后腰椎MRI示突出的椎间盘髓核组织已切除，神经根压迫解除；C：术后1个月腰椎CT三维重建：仅磨除L5及S1部分椎板峡部和下关节突外缘增生，关节突关节及小关节保护良好（箭头所示），未见腰椎不稳或者椎板大面积损伤等情况
Fig.2 Imaging data of patients with L5-S1 intervertebral disc herniation before and after treatment
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