腰椎完全内镜经椎板间入路技术的临床教程

doi:10.6040/j.issn.1671-7554.0.2019.140

摘要/Abstract

摘要： 近年来,经皮脊柱内镜技术得到迅速发展,应用范围越来越广。完全内镜经椎板间入路技术避免了椎间孔入路技术的一些不足,逐渐引起关注和研究,但目前尚缺乏统一的应用规范。如何正确利用经椎板间入路技术,合理把握手术适应证,熟练掌握其操作技巧,避免手术并发症和减少术后复发,进而提高临床疗效,已成为术者必须面对的关键问题。基于十多年完全内镜经腰椎板间入路技术临床实践的经验,详细介绍其发展历程、适应证与禁忌证、手术技巧、并发症及防治,以期进一步推动该技术的发展。

关键词: 腰椎, 完全内镜, 经椎板间入路, 微创技术, 适应证, 并发症

Abstract: In recent years, spinal endoscopic techniques have been rapidly developed and widely used. Full-endoscopic interlaminar approach can avoid the shortcomings of the transforaminal approach; however, it has no standard application protocol yet. Therefore, surgeons are now facing many problems, such as how to apply FEID techniques correctly, what are the surgical indications, how to perform the surgical procedure skillfully, how to avoid complications and reduce postoperative recurrence so as to improve clinical efficacy, and so on. Based on more than ten years' clinical application of FEID techniques, the author will introduce the history of development, surgical indications and contraindications, surgical techniques, and prevention of complications, hopefully to further develop the techniques.

Key words: Lumbar spine, Full-endoscope, Interlaminar approach, Minimally invasive techniques, Indications, Complications

中图分类号:

R681.5

王冰. 腰椎完全内镜经椎板间入路技术的临床教程[J]. 山东大学学报 (医学版), 2019, 57(5): 23-29.

WANG Bing. A clinical guideline of full-endoscopic lumbar interlaminar approach techniques[J]. Journal of Shandong University (Health Sciences), 2019, 57(5): 23-29.

参考文献

[1] Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damaging through a microsurgical approach[J]. Adv Neurosurg, 1977, 4: 74-77.
[2] Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation[J]. Neurosurg Focus, 1999, 7(5): 5.
[3] Yeung AT. Minimally invasive disc surgery with the yeung endoscopic spine system(YESS)[J]. Surg Technol Int, 1999, 8: 267-277.
[4] Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases[J]. Spine(Phila Pa 1976), 2006, 31(24): 890-897.
[5] Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope[J]. Neurosurgery, 2006, 58(1 Suppl): 59-68.
[6] Ruetten S, Komp M, Merk H, et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach[J]. J Neurosurg Spine, 2007, 6(6): 521-530.
[7] Komp M, Hahn P, Merk H, et al. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients[J]. J Spinal Disord Tech, 2011, 24(5): 281-287.
[8] Kim HS, Patel R, Paudel B, et al. Early outcomes of endoscopic contralateral foraminal and lateral recess decompression via an interlaminar approach in patients with unilateral radiculopathy from unilateral foraminal stenosis[J]. World Neurosurg, 2017, 108: 763-773. doi: 10.1016/j.wneu.2017.09.018.
[9] Kim HS, Paudel B, Jang JS, et al. Percutaneous endoscopic lumbar discectomy for all types of lumbar disc herniations(ldh)including severely difficult and extremely difficult ldh cases[J]. Pain Physician, 2018, 21(4):401-408.
[10] 王冰, 吕国华, 李晶, 等. 完全内镜下经椎板间入路治疗腰椎间盘突出症的对比研究[J]. 中华外科杂志, 2011, 49(1): 74-78. WANG Bing, LV Guohua, LI Jing, et al.Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation[J]. Chinese Journal of Surgery, 2011, 49(1):74-78.
[11] Tu Z, Li YW, Wang B, et al. Clinical outcome of full-endoscopic interlaminar discectomy for single-level lumbar disc herniation: a minimum of 5-year follow-up[J]. Pain Physician, 2017, 20(3): 425-430.
[12] Dabo X, Ziqiang C, Yinchuan Z, et al. The clinical results of percutaneous endoscopic interlaminar discectomy(peid)in the treatment of calcified lumbar disc herniation: a case-control study[J]. Pain Physician, 2016, 19(2): 69-76.
[13] Kim CH, Chung CK, Woo JW. Surgical outcome of percutaneous endoscopic interlaminar lumbar discectomy for highly migrated disk herniation[J]. Clin Spine Surg, 2016, 29(5): 259-266.
[14] Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision[J]. J Spinal Disord Tech, 2009, 22(2): 122-129.
[15] Zheng ZZ, Tu Z, Li Y, et al. Full-endoscopic lumbar discectomy for lumbar disc herniation with posterior ring apophysis fracture: a retrospective study[J]. World Neurosurg, 2018, 24: 1-7. doi: 10.1016/j.wneu.2018.12.054.
[16] Tu Z, Wang B, Li L, et al. Early experience of full-endoscopic interlaminar discectomy for adolescent lumbar disc herniation with sciatic scoliosis[J]. Pain Physician, 2018, 21(1): 63-70.
[17] 李振宙, 侯树勋, 宋科冉, 等. 经椎板间完全内镜下L2~5椎间盘摘除术的手术策略[J]. 中国矫形外科杂志, 2014, 22(3): 201-207. LI Zhenzhou, HOU Shuxun, SONG Keran, et al. Surgical strategy of full- endoscopic L2~5 discectomy through an interlaminar approach[J]. Orthopedic Journal of China, 2014, 22(3):201-207.
[18] Hsu HT, Yang SS. Full-endoscopic interlaminar discectomy for herniation at L3-4 and L4-5: Technical note[J]. Formosan Journal of Surgery, 2013, 46(3): 90-96.
[19] Suh SW, Shingade VU, Lee SH, et al. Origin of lumbar spinal roots and their relationship to intervertebral discs: a cadaver and radiological study[J]. J Bone Joint Surg Br, 2005, 87(4): 518-522.
[20] Choi KC, Kim JS, Ryu KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach[J]. Pain Physician, 2013, 16(6):547-556.
[21] Ruetten S, Komp M, Merk H, et al. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study[J]. J Neurosurg Spine, 2009, 10(5): 476-485.
[22] Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study[J]. Pain Physician, 2015, 18(1): 61-70.
[23] Cheng YP, Lee KW, Lin PY, et al. Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation[J]. Surg Neurol Int, 2014, 5: 55. doi: 10.4103/2152-7806.131106.
[24] Ying GY, YaoY, Shen F, et al. Percutaneous endoscopic removal of a lumbar epidural angiolipoma via interlaminar approach: a technical report[J]. World Neurosurg, 2017, 99: 59-62. doi: 10.1016/j.wneu.2016.11.088.
[25] 王冰, 吕国华, 李亚伟, 等. 完全内窥镜下经椎板间入路手术治疗腰椎间盘突出症中期临床疗效[J]. 中国骨与关节杂志, 2014,3(8):603-607. WANG Bing, LV Guohua, LI Yawei, et al. Mid-term clinical outcomes of full-endoscopic interlaminar approach for lumbar disc herniation[J]. Chinese Journal of Bone and Joint, 2014, 3(8):603-607.
[26] Chen HT, Tsai CH, Chao SC, et al. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: Prospective controlled study under local and general anesthesia[J]. Surg Neurol Int, 2011, 2: 93. doi: 10.4103/2152-7806.82570.
[27] Poletti CE. Central lumbar stenosis caused by ligamentum flavum: unilateral laminotomy for bilateral ligamentectomy: preliminary report of two cases[J]. Neurosurgery, 1995, 37(2): 343-347.
[28] Wang B, Lu G, Liu W, et al. Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: the causes and prophylaxis of conversion to open[J]. Arch Orthop Trauma Surg, 2012, 132(11): 1531-1538.
[29] Wang B, Lu G, Patel AA, et al. An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations[J]. Spine J, 2011, 11(2): 122-130.

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