单边双通道内镜技术在腰椎疾病中的应用研究进展  

Development and application of unilateral biportal endoscopy in lumbar diseases

作　　者：朱斌[1] 田大胜[1] 陈磊[1] 王其飞 孙一松 钟华璋 王义国 刘建军 荆珏华[1] Zhu Bin;Tian Dasheng;Chen Lei;Wang Qifei;Sun Yisong;Zhong Huazhang;Wang Yiguo;Liu Jianjun;Jing Juehua(Department of Orthopaedics,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院骨科,合肥230601

出　　处：《中华骨科杂志》2020年第15期1030-1038,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(61872407)。

摘　　要：单边双通道内镜技术是指通过后路单侧两个小切口分别建立经皮观察和操作通道,观察通道内放置内窥镜监视手术视野,操作通道内放置操作工具用于椎管内外手术操作。双通道分离的特点使该技术区别于同轴内窥镜技术,具有视野清晰开阔、操作灵活方便、手术器械要求相对简单等优势。近年有关单边双通道内镜手术在脊柱疾病中应用的临床报告逐渐增多。手术适应证包括腰椎间盘突出症髓核摘除、腰椎管狭窄症减压、内镜下椎体间融合以及椎管内外占位性病变的切除等;手术节段也从腰椎逐渐扩展到颈椎和胸椎,均取得了良好的临床手术效果而受到关注。单边双通道内镜技术具有手术创伤小和康复过程快等优点,镜下手术视野范围大,结构辨认清晰,接近开放手术,学习曲线相对平缓。虽然在理论上具有优势,但神经损伤、术后下肢麻木等并发症仍屡见报道。熟练单边双通道技术操作流程、掌握镜下局部解剖层次、把握镜下椎管内手术操作细节等对成功应用单边双通道技术治疗各种腰椎疾患至关重要。The unilateral biportal endoscopic technique is defined as posterior unilateral of two small incision with established percutaneous observation channel and endoscopic observation channel in monitoring field.The operation tools were placed within the channel for each operation inside and outside vertebral canal.The characteristics of dual channel intervention make this technology different from coaxial endoscopic technology.This technique has a clear vision for flexible and convenient operation with the advantages of relatively simple surgical instrument requirements.In recent years,the use of unilateral dual channel endoscopic surgery in treating spinal diseases was gradually increasing,especially in the removal of nucleus including lumbar intervertebral disc protrusion and lumbar spinal stenosis disease decompression,and in endoscopic space-occupying lesions such as vertebral fusion and spinal canal between inside and outside.It was also applied in cervical and thoracic diseases with good clinical effects.Its advantages include less surgical trauma and faster recovery process.In addition,it has a large surgical field of vision under the microscope for easy identification of structures and surgery and with relatively gentle learning curve.Thus,it is conducive to beginners'mastery.However,complications such as nerve injury and postoperative lower limb numbness are still frequently reported.Some factors have to be considered,including insufficient understanding of the new technology,the local anatomy of the dual-channel endoscope,the operation of the spinal canal under the microscope.The successful application of the technique in treating various lumbar diseases needs understanding the operation process of the technique and local anatomy under the microscope.

关 键 词：腰椎管狭窄症 内窥镜技术 脊柱疾病 下肢麻木 康复过程 操作细节 腰椎疾病 手术视野 

分 类 号：R687.3[医药卫生—骨科学]