腰椎间盘突出症的微创治疗进展

Advance in minimally invasive treatment of lumbar disc herniation

腰椎间盘突出症是骨科的常见病和多发病。近年来,随着对腰椎间盘突出症(LDH)发病机制的系列深入研究,脊柱外科得到快速地发展,越来越多的具有创伤小、恢复快、并发症少的微创技术被应用于该病的治疗。治疗腰椎间盘突出症的微创技术主要包括经皮髓核化学溶解术、经皮穿刺臭氧溶解术、经皮腰椎间盘摘除术(PLD)、经皮激光椎间盘减压术(PLDD)、后路显微椎间盘镜髓核摘除术(MED)以及侧后路椎间孔镜下髓核摘除术(PTED)。经皮髓核化学溶解术、臭氧溶解术、PLD、PLDD,具有手术创伤小、术后恢复快、安全性高、疗效好及并发症少等优点,手术适应证以隆起型椎间盘突出为主。而MED和PTED技术,学习曲线较陡峭,手术疗效确切,几乎适用于所有类型的腰椎间盘突出症。本文主要阐述了治疗腰椎间盘突出症的各种微创手术的利弊及其在临床上的应用。

Lumbar disc herniation （LDH） is a common and frequently-occurring disease. In recent years, with the deep research in the pathogenesis of LDH, the spine department receives the rapid development. More and more minimally invasive techniques appear, which have advantages of minimal invasion, less complication as well as quickly recovery. The mini-invasive treatment of LDH mainly includes collagenase chemonucleolysis, percutaneous puncture of ozone dissolution, percutaneous lumbar discectomy, percutaneous laser disc decompression, microendoscopic discectomy, percutaneous trasforaminal endoscopic discectomy. Collagenase chemonucleolysis, percutaneous puncture of ozone dissolution, pereutaneous lumbar excision and percutaneous laser disc decompression with small incision but accurate operation, quick recovery, high security and good curative effect and less complications, and surgical indication is given priority to the protrude type of intervertebral disc herniation. However, MED and PTED have a steep learning curve and surgical curative effect, and almost are suitable for all types of LDH. This article mainly expounds the various pros and cons of all kinds of minimally invasive surgryon treatment of LDH.