经皮内镜辅助腰椎椎间融合术的技术利弊分析及趋势展望

Analysis of technical advantages and disadvantages of percutaneous endoscopic lumbar interbody fusion and its trend prospect

目的对经皮内镜辅助腰椎椎间融合术的技术利弊、研究进展进行综述和评价。方法广泛查阅国内外关于经皮内镜辅助腰椎椎间融合术的相关研究文献,对各种技术优缺点及临床疗效进行总结,对未来发展趋势进行展望。结果与微创经椎间孔入路腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)比较,经皮内镜辅助腰椎椎间融合术中及术后出血更少、早期腰部疼痛改善更明显,且远期临床疗效、融合率、并发症发生率相似,但学习曲线较长。单边双通道及大通道内镜下融合的手术时间接近于MISTLIF,但小通道内镜下融合的手术时间长于MIS-TLIF。结论经皮内镜辅助腰椎椎间融合术具有手术创伤小、临床疗效好的优点,但学习曲线较长,应严格选择手术适应证循序开展该技术。随着各种镜下融合技术不断发展并相互补充,该技术将具有更好的应用前景。

Objective To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion.Methods The domestic and foreign related research literature on percutaneous endoscopic lumbar interbody fusion was extensively consulted.The advantages,disadvantages,and effectiveness were summarized.And the development trend of this technology was prospected.Results Compared with minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),percutaneous endoscopic lumbar interbody fusion has less intraoperative and postoperative bleeding,better improvement of low back pain in the early stage after operation,and similar long-term effectiveness,fusion rate,and incidence of complication,but a longer learning curve.The operation time of biportal and large-channel uniportal endoscopic lumbar fusion is close to that of MIS-TLIF,but the operation time of small-channel uniportal endoscopic fusion is longer than that of MIS-TLIF.Conclusion Percutaneous endoscopic lumbar interbody fusion has the advantages of less trauma and good effectiveness,but its learning curve is long,and indications should be strictly selected for this operation.In the future,with the continuous development and complementation of various endoscopic fusion technologies,this technology will gain better application prospects.