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椎间孔镜Beis技术治疗向上游离型腰椎间盘突出症1例

2019-05-18 高琨 胡美琴 秦练 临床骨科杂志

患者,男,53岁,因腰痛伴左下肢放射痛麻木6个月,加重伴行走困难1d,急诊入院。体检:腰部活动受限,棘突旁压痛(+),左下肢直腿抬高试验(+)40°,加强试验(+),左侧下肢麻木,双侧鞍区感觉无殊,无大小便障碍,左下肢肌力3级,右下肢肌力4级。腰椎CT及MRI检查示髓核向上游离(见图1)。诊断:急性腰椎间盘突出症(向上游离型)。

临床资料

患者,男,53岁,因腰痛伴左下肢放射痛麻木6个月,加重伴行走困难1d,急诊入院。体检:腰部活动受限,棘突旁压痛(+),左下肢直腿抬高试验(+)40°,加强试验(+),左侧下肢麻木,双侧鞍区感觉无殊,无大小便障碍,左下肢肌力3级,右下肢肌力4级。腰椎CT及MRI检查示髓核向上游离(见图1)。诊断:急性腰椎间盘突出症(向上游离型)。



讨论

局麻下急诊行经皮穿刺椎间孔镜下髓核摘除视频消融术(Beis技术)。C臂机透视证实穿刺针正位位于下位椎体后上缘中间处,侧位位于下位椎体上关节突尖部。逐级扩张,然后使用各级环锯扩大椎间孔,置入工作管道,插入内窥镜,调整工作通道及镜头方向,通过镜下辨认椎管内组织,确认为游离及突出的髓核组织后,使用各种抓钳将游离的椎间盘组织完整取出(见图2)。术后卧床休息1d,双下肢麻木疼痛基本消失。左下肢直腿抬高试验转为阴性,左下肢肌力变为4级,右下肢肌力变为5级。佩戴腰部支具下地活动。



原始出处:

高琨,胡美琴,秦练.椎间孔镜Beis技术治疗向上游离型腰椎间盘突出症1例[J].临床骨科杂志,2018,21(06):721.

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