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CT引导的经皮穿刺腰椎间盘摘除术 |
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刘德隆 田世杰 王进军 苏庆军 杨煦 郭玉珠 曹宝信
【摘要】目的 探讨CT引导的经皮穿刺治疗腰椎间盘突出症的临床应用价值。方法 在CT引导下对32例腰椎间盘突出患者，利用CT提供的三维图像穿刺定位，并在三维控制下选择最佳穿刺平面和最佳穿刺途径，进行经皮穿刺椎间关节镜腰椎间盘摘除术。其中男18例，女14例。年龄19～59岁，平均40.5岁。随访2～8个月，平均6个月。并与“C”型臂X线透视引导的手术进行比较。结果 切取椎间盘组织量，L4，5间隙由平均2.3g增加至4.1g，L5S1间隙由平均2.15g增加至3.25g。手术优良率由82.2％，提高至90.6％。结论 CT引导提高了手术准确性，利于最大程度的切取椎间盘组织，降低椎间盘内压力，使突出的椎间盘还纳。
【关键词】腰椎 椎间盘 压力
Percutaneous CT Guided Lumbar Discectomy
LIU Delong, TIAN Shijie,WANG Jinjun,et al.
Department of Orthopaedic Surgery, Beijing Red Cross Chaoyang Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100020
【Abstract】 Objctive To evaluate the clinical significance of percutaneous microscopic discectomy guided by computed tomography. Methods 32 patients were included in this study. There were 18 males and 14 females. The mean age was 40.5 years(range,19－59 years). The duration of follow up ranged 2 to 8 months, with an average of 6 months. Position-setting and puncture were introduced under three－dimensional CT, and compared with those under C-arm-X-ray. Result The quantity of removed tissue from the disc was increased from 2.3 g to 4.1 g at L4－5 space,and from 2.15 g to 3.25 g at L5－S1 space. The excellent and good rate was 90.6％ . Conclusion The CT guided percutaneous lumbar discectomy make the puncture more precise, and the disc tissue could be taken off fully. As a result,entradiscal pressure was reduced and protrution of the disc was eliminated.
【Key words】 Lumbar vertebrae Intervertebral disk Pressure
自1992年以来，我院在“C”型臂X线透视引导下进行经皮穿刺椎间关节镜腰椎间盘摘除术377例，取得了较好的临床效果。为了进一步提高穿刺的准确性，使穿刺针更接近椎间盘突出位置，提高减压效果，自1996年2月起，我院开展了在CT引导下经皮穿刺腰椎间盘摘除术，共施行手术32例，取得较好疗效。
临床资料
本组共32例，34个椎间隙，67次穿刺，33个椎间隙为双侧穿刺，1个椎间隙单侧穿刺。男18例，女14例，年龄19～59岁，平均40.5岁。椎间盘膨出型2例，突出型28例，脱出型2例，无游离型。穿刺L4，5间隙27例，L5S1间隙7例。CT测量穿刺各椎间盘参数如下：L4，5穿刺点距中线的距离最小5cm，最大12cm，平均9.3cm，进针角度33°～45°，穿刺针尾向头侧倾斜4°[1] [2] 下一页
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