| 杨赛帅,崔志明,徐冠华,等.应用可弯曲等离子刀头行椎间盘精准靶点消融治疗青少年腰椎间盘突出症的临床观察[J].安徽医药,2026,30(8):1591-1595. |
| 应用可弯曲等离子刀头行椎间盘精准靶点消融治疗青少年腰椎间盘突出症的临床观察 |
| Clinical observation on the application of flexible plasma probe for precise target ablation in treating adolescent lumbar disc herniation |
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| DOI：10.3969/j.issn.1009-6469.2026.08.021 |
| 中文关键词: 椎间盘移位 椎间盘切除术，经皮 腰椎 青少年 等离子 消融 可弯曲刀头 |
| 英文关键词: Intervertebral disc displacement Diskectomy, percutaneous Lumbar vertebrae Adolescent Plasma Ablation Flexible blade head |
| 基金项目: |
| 作者 | 单位 | E-mail | | 杨赛帅 | 东南大学附属南通市第一人民医院,麻醉疼痛科,江苏南通 226001 | | | 崔志明 | 东南大学附属南通市第一人民医院,脊柱外科,江苏南通 226001 | | | 徐冠华 | 东南大学附属南通市第一人民医院,脊柱外科,江苏南通 226001 | | | 孙鑫 | 东南大学附属南通市第一人民医院,麻醉疼痛科,江苏南通 226001 | | | 黄家乐 | 东南大学附属南通市第一人民医院,脊柱外科,江苏南通 226001 | | | 陈佳佳 | 东南大学附属南通市第一人民医院,脊柱外科,江苏南通 226001 | ntspine@ntu.edu.cn |
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| 中文摘要: |
| 目的探讨应用可弯曲等离子刀头行椎间盘精准靶点消融治疗青少年腰椎间盘突出症的早期临床疗效。方法回顾性分析 2021年 7月至 2024年 10月东南大学附属南通市第一人民医院收治的 33例青少年腰椎间盘突出症病人，局麻下从健侧 /双侧穿刺到椎间盘后，采用可弯曲等离子刀头调整至突出靶点位置行低温等离子消融术治疗。记录并比较术前、术后不同时间点腰痛、腿痛的视觉模拟评分法( VAS)评分、 Oswestry功能障碍指数(ODI)评分、日本骨科协会(JOA)评分。术后复查腰椎磁共振成像( MRI)观察手术节段椎间盘突出部位变化及退变情况。结果所有病人均获得随访，平均随访时间为 25.9个月，随访时间范围为 8~41个月。病人平均手术时间 63 min，手术时间 35~115 min，平均透视次数 33.4次/节段，透视次数 14~86次。病人腰痛、腿痛 VAS评分在术后 1d［( 2.02±0.56)分、(2.61±0.64)分］、术后 1个月［(1.36±0.40)分、(1.94±0.67)分］、术后 3个月［( 1.09±0.52)分、(1.51±0.84)分］、末次随访［( 0.82±0.53)分、(1.03±0.71)分］时均低于术前［(4.03±0.55)分、(5.87±0.88)分］(P<0.01)。病人的 ODI评分， JOA评分在术后 1个月、术后 3个月、末次随访时也较术前明显改善( P<0.01)治疗改善的优良率 93.9%。术后复查腰椎 MRI显示突出部位髓核均有不同程度缩小，未见手术节段椎间盘塌陷，椎体不稳。2例病人手术节段椎间盘退变加重， 2例病人手术节段出现终板炎， 2例病人术后恢复欠佳再次行椎间孔镜下髓核摘除术。结论应用可弯曲等离子刀头行椎间盘精准靶点消融，手术创伤小、直达突出髓核靶点、安全性较高且中短期随访疗效满意，为青少年腰椎间盘突出 |
| 英文摘要: |
| Objective To investigate the early clinical efficacy of precise target ablation using a flexible plasma probe for treating ad-olescent lumbar disc herniation (ALDH).Methods A retrospective analysis was performed on 33 ALDH patients admitted to NantongFirst People's Hospital, Southeast University from July 2021 to October 2024. Under local anesthesia, percutaneous puncture was per-formed from the healthy side/bilateral side to the target disc, and a flexible plasma probe was then adjusted to the herniated target sitefor coblation nucleoplasty. The visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and JapaneseOrthopaedic Association (JOA) score were recorded and compared preoperatively and at different postoperative time points. Postopera-tive lumbar MRI was performed to observe the changes in the herniated disc and degeneration at the surgical segment.Results All pa-tients were followed up for a mean duration of 25.9 months (range: 8-41 months). The average operation time of patients was 63.0 min-utes (ranging from 35 to 115 minutes), and the average number of fluoroscopies was 33.4 per segment (ranging from 14 to 86 times).VAS scores for both low back pain and leg pain were significantly lower at 1 day [(2.02±0.56) points, (2.61±0.64) points], 1 month[(1.36±0.40) points, (1.94±0.67) points], 3 months [(1.09±0.52) points, (1.51±0.84) points] postoperatively, and at the final follow-up [(0.82±0.53) points, (1.03±0.71) points] compared to preoperative scores [(4.03±0.55) points, (5.87±0.88) points] (P < 0.01). ODI and JOA scores also showed significant improvement at 1 month, 3 months postoperatively, and at the final follow-up (P < 0.01). The overallexcellent and good rate of treatment improvement was 93.9%. Postoperative MRI demonstrated varying degrees of reduction in the her-niated nucleus pulposus at all target sites, with no evidence of disc collapse or segmental instability at the operated levels. Increaseddisc degeneration was observed at the surgical level in 2 patients, Modic changes developed in 2 patients, and 2 patients underwentsubsequent transforaminal endoscopic discectomy due to suboptimal recovery.Conclusions Precision targeted ablation using a flexi-ble plasma probe is a minimally invasive technique that directly accesses the herniated nucleus pulposus target. It demonstrates rela-tively high safety. Current clinical observations indicate that this technique may provide positive outcomes during short-to mid-term fol-low-up, demonstrating potential as an alternative option within the stepped care strategy for adolescent lumbar disc herniation. |
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