經皮下自動腰部椎間盤摘除術之摘除時間之探討及其臨床上應用之可行性

為了要探討經皮下自動腰部椎間盤手術 ( Automated Percutaneous Lumbar Diskectomy : APLD ) 之最適當操作時間範圍, 本研究用了動物實驗來做客觀性之探討且給予統一標準化定量化後, 以此做為佐證再配合其臨床上之應用 ( clinical trial ) 來探討其可行性. 本文嘗試解剖18隻正常健康活體成豬, 把其腰部脊椎完整取出後做了90個椎間盤之經皮下自動腰部椎間盤摘除術, 以分段性之時間差異來分析探討其在質量上及椎間盤內壓上 ( intra discal pressure ) 和質量相對高度上之相關性, 並給予定量化後以此動物實驗之結果作為佐證再應用於臨床上所嚴選之36位病患做了38個椎間盤之經皮下自動腰部椎間盤摘除術後給予分析評估. 最後再與過去本科以往之固定手術操作時間 ( 40 ~ 45 分鐘 ) 作為對照組 ( case - control study ) 來分析其中之差異性. 根據以上之結果, 本研究認為在動物實驗及臨床應用上20 ~ 25 分鐘是經皮下自動腰部椎間盤手術之最適當手術操作時間範圍. 其所摘除之椎間盤平均質量為1.5 ~ 2.0 gm . 既-達到治療效果所需之質量. 其臨床應用之成績 ( 成功率69.9 % ) 與對照組之成績 ( 40 ~ 45分鐘 : 成功率 71.1 % ) 以及國外之成績報告 ( 60 ~ 90 % ) 亦非常接近, 由此可推測操作時間範圍應可短縮至20 ~ 25 分鐘而不影響其治療效果. 故20 ~ 25 分鐘是經皮下自動腰部椎間盤手術之最適當手術操作時間, 且應可以做為臨床上應用之參考標準時間.

關鍵字

椎間盤突出症；經皮下自動腰部椎間盤摘除術

並列摘要

The purpose of this study was to clarified the optimal duration of operation as well as the feasibility of Automated Percutaneous Lumbar Diskectomy : APLD . In this study animal test was run to facilitate objective discussion and that followed with uniform standardized quantitization to serve as supporting evidence together with clinical application . Eighteen normal healthy grown pigs were sacrified and 90 lumbar vertebral disks were performed with Automated Percutaneous Lumbar Diskectomy , which were executed to study correlation as regards mass , intradiscal pressure and mass related height in terms of stagewise timing difference , duly quantized , with the result taken as supporting evidence to evaluate 38 vertebral disks APLD cases performed on 36 patients selected clinically , in respect of which differential was studied analytically through case - control study using control groups each lasting 40 ~ 45 minutes per operation conducted at this orthopaedic department previously . The finding indicates that in animal test as well as clinical applications the optimal duration of an APLD operation is of the order of 20 to 25 minutes , the mean mass of nucleus pulposus aspiration cutting weight was 1.5 to 2.0 gm , so to speak , the mass required to attain therapeutic effect . As represented in clinical results ( success rate : 69.9 % ) , it is very closed to the corresponding result on the part of control group ( 40 ~ 45 min ; success rate 71.1 % ) , and foreign report : 60 ~ 90 % , that serving to recommend for the duration of an operation to being cut down to 20 ~ 25 minutes without affecting therapeutic effect . So the conclusion is derived that the optimum duration of an APLD vertebral disk operation lasts about 20 ~ 25 minutes and that serving rightly as a standard term for reference in clinical application .

並列關鍵字

herniation of intervertebral disk ； automated

參考文獻

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經皮下自動腰部椎間盤摘除術之摘除時間之探討及其臨床上應用之可行性

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