腰椎退行性疾病外科治疗的发展与趋势  

The development and trend of surgical treatment of lumbar degenerative diseases

作　　者：宋跃明[1] 丰干钧[1] SONG Yueming;FENG Ganjun(West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院,四川成都610041

出　　处：《西部医学》2024年第8期1093-1096,共4页Medical Journal of West China

摘　　要：随着人口老龄化的发展,腰椎退行性疾病的患病率持续增加,腰椎外科治疗技术也逐渐向微创化发展。传统开放手术虽然疗效稳定,但可能导致脊柱后方结构的破坏和瘢痕化。目前微创腰椎手术的焦点包括单纯减压、镜下融合和斜外侧腰椎椎间融合术(OLIF)三个方面。对于单纯减压,腰椎间盘摘除术可以通过显微镜、显微内镜椎间盘摘除术(MED)、单侧双通道内镜(UBE)及全内镜(FE)等方式实施。其中FE创伤最小,经椎间孔入路腰椎间盘摘除术(PETD)和经椎板间入路腰椎间盘摘除术(PEID)各有优势,UBE技术则因其灵活性和清晰视野成为近年来的优势技术。对于镜下融合,其主要用于治疗腰椎滑脱症,恢复正常腰椎序列。其中FE-TLIF和UBE-TLIF手术创伤小、恢复快、融合率高。相比腰椎前路椎间融合术(ALIF)和极外侧腰椎椎间融合术(XLIF),OLIF具有创伤小、植骨面大、矫正脊柱畸形等优点,能有效减少腹腔血管损伤及神经损伤等并发症。总体来看,腰椎微创技术发展迅速,结合机器人和导航技术将提高手术精准性和微创程度,有望推动腰椎退行性疾病向精准化、个体化治疗发展,并降低医疗成本。With an aging population,the prevalence of lumbar degenerative diseass is increasing,driving advancements in minimally invasive lumbarspine surgery techniques.Traditional open surgery,while effective,can cause damage and scarring to posterior spinal structures.Current minimally invasive lumbar spine surgery focuses on decompression,endoscopic fusion,and Oblique Lumbar Interbody Fusion(OLIF).For decompression,lumbar discectomy can be performed using a Microendoscopic Discectomy(MED),Unilateral Biportal Endoscopy(UBE),and Full-Endoscopic(FE)methods,with FE causing the least trauma.Percutaneous Endoscopic Transforaminal Discectomy(PETD)and Percutaneous Endoscopic Interlaminal Discectomy(PEID)have distinct advantages,and UBE has emerged as a leading technique due to its flexibility and clear visual field.Endoscopic fusion,primarily used to treat lumbar spondylolisthesis,aims to restore normal lumbar alignment.FE-TLIF and UBE-TLIF procedures are minimally invasive,promote quick recovery,and have high fusion rates.OLIF offers benefits such as minimal trauma,a larger graft area,and effective correction of spinal deformities.Compared to Anterior Lumbar Interbody Fusion(ALIF)and Extreme Lateral Lumbar Interbody Fusion(XLIF),OLIF significantly reduces the risk of vascular and neural complications.Overall,the rapid development of minimally invasive lumbar techniques,combined with robotic and navigational technologies,is expected to enhance surgical precision and minimal invasiveness,promoting personalized treatment of lumbar degenerative diseases and reducing healthcare costs.

关 键 词：腰椎退行性疾病 外科治疗 腰椎微创手术 

分 类 号：R681.5[医药卫生—骨科学]