经皮椎间孔入路全内镜技术治疗腰椎间盘突出症

Transforaminal percutaneous endoscopic lumbar discectomy for lumbar disc herniation

一、前言 腰椎间盘突出症是一种常见病、多发病，手术治疗方法可以分为传统开放手术和微创手术两大类。近些年来，微创脊柱外科以其创伤小、恢复快等优点，取得了快速的发展进步，在腰椎间盘突出症的治疗中获得了显著疗效。其中经皮内镜椎间盘摘除技术是目前创伤最小的镜下椎间盘摘除术式。经皮内镜技术通过带工作通道的硬杆状内窥镜在生理盐水持续灌洗下进行，可在直视下对病变椎间盘进行操作，因其操作全程在内窥镜下完成，故又称为全内镜技术。

Transforaminal percutaneous endoscopic lumbar discectomy （ TF-PELD ） is a minimally invasive procedure, which has developed very fast recently. The appearance of Yeung Endoscopy Spine System （ YESS ） marked the maturation of TF-PELD. The YESS consists of a video system and a rigid endoscope including optical fiber lighting, wide-angle lens, some irrigation channels and a working channel. Inclusive lumbar disc herniation can be treated, but it is inadaptable for herniated lumber disc prolapsed in the canal. The cross-sectional area of the intervertebral foramen will be expanded by using Transforaminal Endoscopic Spine System （ TESSYS ）, so as to put the working tube into the canal. The puncture point is moved outside and the working tube will be put into the canal in the＂far-lateral technique＂invented by Ruetten et al. The deifciency of YESS is offset by the 2 techniques stated above, and the operation indications of TF-PELD are extended. In recent 20 years, the side injuries have been constantly reduced and as good clinical results as in traditional decompression procedures have been achieved. TF-PELD will hold a bright prospect.