单纯超声引导下经皮椎间孔镜腰椎间盘切除术一例

doi:10.3877/cma.j.issn.1674-6899.2019.02.012

中华腔镜外科杂志(电子版) ›› 2019, Vol. 12 ›› Issue (02) : 111 -114. doi: 10.3877/cma.j.issn.1674-6899.2019.02.012

所属专题：经典病例；经典病例；文献；

病例报告

单纯超声引导下经皮椎间孔镜腰椎间盘切除术一例

张明博¹, 黄鹏²^,^†(

), 武成志², 闫龙涛³

^1. 100853　北京，解放军总医院第一医学中心超声诊断科
^2. 100853　北京，解放军总医院骨科
^3. 100029　北京，中日友好医院疼痛科

收稿日期:2019-03-26 出版日期:2019-04-30
通信作者: 黄鹏
基金资助:
解放军总医院临床科研扶持基金(2018XXFC-18)

Ultrasound guided percutaneous transforaminal endoscopic lumbar discectomy with no radiation: a case report

Mingbo Zhang¹, Peng Huang²^,^†(), Chengzhi Wu², Longtao Yan³

^1. Department of Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
^2. Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
^3. Department of Pain, China-Japan Friendship Hospital, Beijing 100029, China

Received:2019-03-26 Published:2019-04-30
Corresponding author: Peng Huang
About author:
Corresponding author: Huang Peng, Email: harryhp@vip.sina.com

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目的

探讨单纯超声引导下经皮椎间孔镜腰椎间盘切除术的可行性。

方法

以腰椎横突为标志物，超声在纵切面上定位腰椎节段，在横切面上以横突头侧的高回声区作为穿刺和置管的靶点进行实时引导。

结果

术后患者症状明显减轻。术后MRI显示，椎间盘突出部髓核的实体组织已完全切除，神经根已完全松解，无并发症。

结论

本文是国际首例超声引导下的零辐射经皮椎间孔镜腰椎间盘切除术报道(医疗卫生科技查新报告2019023号；解放军总医院医疗卫生科技查新站；查新时间2019年3月18日)。超声引导将明显降低，甚至有望完全取代椎间孔镜手术中穿刺置管过程的X线辐射，具有重要临床价值。

关键词: 超声, 辐射, 经皮椎间孔镜腰椎间盘切除术, 腰椎间盘突出症

Objective

To explore the possibility of ultrasound guided percutaneous transforaminal endoscopic lumbar discectomy (PELD) with no radiation.

Methods

The lumbar transverse processes were used as the markers to locate the target level on longitudinal section. A hyperechoic zone on transverse section of lumbar ultrasound was used as the marker to puncture and cannulation of PELD, and the operation was completed.

Results

After operation, the symptoms were relieved obviously. Postoperative MRI showed that the solid tissue of nucleus pulposus in the herniated disc had been completely removed, and the nerve root had been completely released without complications.

Conclusions

This is the first case of zero radiation PELD guided by ultrasound in the world(Report of Novelty Search of Medical and Health Science and Technology No. 2019023; Novelty Search Station of Medical and Health Science and Technology, General Hospital of PLA; Novelty Search Time, March 18th, 2019). It has important value to further reduce the radiation dose of PELD during puncture and intubation under the guidance of ultrasound.

Key words: Ultrasound, Radiation, Endoscopic lumbar disectomy, Lumbar disc herniation

图1 左侧腰椎横切面超声图像

图2 PELD术前术后MRI图像

图3 超声引导下穿刺置管过程

图4 PELD手术过程

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