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首页> 外文学位 >Evaluation of a novel surgical procedure for removal of the nucleus pulposus in lumbar intervertebral discs.
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Evaluation of a novel surgical procedure for removal of the nucleus pulposus in lumbar intervertebral discs.

机译：评价一种新颖的手术方法，以去除腰椎间盘内的髓核。

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摘要

Chronic low back pain is one of the most common problems of all age groups worldwide. If conservative treatment fails, the following surgical options -- depending on the underlying cause - currently apply: lumbar discectomy, disc arthroplasty or fusion surgery as the ultimate procedure. An emerging technique, nucleoplasty, aims at targeting early stages of disc degeneration. There are various mechanical, polymeric or tissue engineered devices for nucleus pulposus replacement, some of which have been subjects of studies and clinical trials. We are already looking back at a history of failed devices; as well, complications have been reported such as migration, extrusion and subsidence. On most devices, no long-term data are available yet. Our theory is that for any successful nucleus pulposus replacement in order to stabilize, delay or even improve lumbar disc degeneration, an appropriate cavity has to be created prior to injection or implantation of a new device. The current gold standard procedure to get nucleus pulposus material out of the intervertebral disc is the classic open microdiscectomy which is performed with pituitary rongeurs. Another surgical procedure of a percutaneous nuclectomy via arthroscopic shavers was investigated and the outcome -- size and location of the created cavity - compared with the established rongeur-method, using three different approaches: anteriolateral, posteriolateral and posterior access to the intervertebral disc. The cavities were larger when created with the rongeurs, however, after some modification of instruments, for example curved shavers, nuclectomy via automated shavers might be a good and less invasive surgical alternative.
机译：慢性腰背痛是全世界所有年龄组中最常见的问题之一。如果保守治疗失败，则根据根本原因，目前可采用以下外科手术选择：腰椎间盘切除术，椎间盘置换术或融合术为最终手术。核成形术是一种新兴技术，旨在针对椎间盘退变的早期阶段。有多种机械，聚合物或组织工程化的装置用于髓核置换，其中一些已经成为研究和临床试验的主题。我们已经在回顾发生故障的设备的历史；同样，也有并发症，如迁移，挤压和下陷。在大多数设备上，尚无长期数据。我们的理论是，对于任何成功的髓核置换以稳定，延迟甚至改善腰椎间盘退变，必须在注射或植入新装置之前创建适当的腔。当前将髓核材料从椎间盘中取出的金标准手术是经典的开放式微盘切除术，该手术是通过垂体钳进行的。研究了通过关节镜剃须刀进行的另一种经皮核仁切除术的手术程序，并使用三种不同的方法（即前外侧，后外侧和后方进入椎间盘），比较了已建立的咬骨钳方法的结果-产生的腔的大小和位置。用钳口钳制成的腔较大，但是，在对器械（例如弧形剃须刀）进行一些修改后，通过自动剃须刀进行核仁切除术可能是一种好的且侵入性较小的手术替代方法。

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  • 作者

    Huemmer, Carmen.;

  • 作者单位

    McGill University (Canada).;

  • 授予单位 McGill University (Canada).;
  • 学科 Engineering Biomedical.;Health Sciences Surgery.
  • 学位 M.Sc.
  • 年度 2012
  • 页码 104 p.
  • 总页数 104
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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