经皮椎间孔镜腰椎间盘切除术的诊疗进展

Progress in diagnosis and treatment of percutaneous endoscopic lumbar discectomy

腰椎间盘突出症是骨科常见疾病之一。经皮椎间孔镜下腰椎间盘切除术(PELD)已逐渐发展成为一线手术方式。相较于开放式椎间盘切除术、小开窗椎间盘切除术,PELD具有手术时间短、出血量少、并发症发生率低的优势,但术后复发率相对较高、学习曲线陡峭,单侧双通道脊柱内镜技术、经皮内镜下腰椎融合术可能成为PELD的有效补充。导航和3D打印技术的联合、多模式非线性光学显微镜、核磁与人工智能(如深度学习、卷积神经网络)联合等新技术,将有助于提高PELD的定位和组织的辨别能力,预测手术难度和术后复发,缩短学习曲线,促进PELD推广应用。

Lumbar disc herniation is one of the common orthopedic diseases.Percutaneous endoscopic lumbar discectomy(PELD)has gradually become a first-line surgical approach.Compared with open discectomy and open lumbar microdiscectomy,PELD has shorter operation time,less bleeding and lower complication rate,but the postoperative recurrence rate is relatively high and the learning curve is steep.Unilateral biportal endoscopic discectomy and full endoscopic transforaminal lumbar interbody fusion may be effective supplements to PELD.New technologies such as the combination of navigation and 3D printing technology,multi-mode nonlinear optical microscope,the combination of nuclear magnetic resonance imaging and artificial intelligence(such as deep learning and convolution neural network)will help to improve the accuracy of positioning and tissue discrimination of PELD,predict the surgical difficulty and postoperative recurrence,shorten the learning curve,and promote the popularization and application of PELD.