内镜下手术治疗重度游离型腰椎间盘突出症的研究进展  

Research Progress of Endoscopic Surgery in the Treatment of Highly Migrated Lumbar Disc Herniation

作　　者：许一凡 杜宇[1] 

机构地区：[1]重庆医科大学附属第二医院骨科,重庆

出　　处：《临床医学进展》2024年第5期2294-2301,共8页Advances in Clinical Medicine

摘　　要：重度游离型腰椎间盘突出症(HM-LDH)被认为是一种特殊形式的腰椎间盘突出症。随着微创脊柱技术的不断进步,经皮脊柱内镜下的腰椎髓核切除术成为众多外科医生治疗腰椎间盘突出症的首选方案。对于重度游离型腰椎间盘突出症,传统手术路径如经椎板间入路,经椎间孔入路时,难以彻底移除游离的髓核组织,可能导致减压不完全。并且存在诸如神经根损伤、关节损伤等并发症的风险。经对侧椎间孔入路对同侧小关节损伤较小,但长距离操作损伤神经风险较大。经椎板打孔入路能降低神经损伤风险,却难度较高。本研究回顾了国内外的相关文献,对内镜下手术治疗HM-LDH的方法、治疗效果以及并发症进行了综述,旨在为临床诊疗提供参考依据。Highly migrated lumbar disc herniation is considered to be a specific form of lumbar disc herniation. With the development of minimally invasive spinal techniques, percutaneous endoscopic lumbar nucleuspodemectomy has become the first choice for many surgeons to treat lumbar disc herniation. For highly migrated lumbar disc herniation, traditional surgical approaches such as the interlaminar approach or the foraminal approach are difficult to completely remove the free nucleus pulposus tissue, which may lead to incomplete decompression. There is also a risk of complications such as nerve root damage and joint damage. The contralateral foraminal approach has little damage to the ipsilateral facet joints, but the long distance operation has a greater risk of nerve damage. Translaminar perforation can reduce the risk of nerve damage, but it is difficult. This study reviewed the relevant literature at home and abroad, and reviewed the methods, therapeutic effects and complications of endoscopic surgery for HM-LDH, aiming to provide reference for clinical diagnosis and treatment.

关 键 词：腰椎间盘突出症 重度游离突出 经皮脊柱内镜 

分 类 号：R68[医药卫生—骨科学]