经皮椎间孔镜技术治疗腰椎间盘突症进展.docVIP

经皮椎间孔镜技术治疗腰椎间盘突症进展 　　[摘要] 腰椎间盘突出症是骨科的常见病和多发病，大部分患者经保守治疗后症状可以缓解，仅10%的患者最终需要手术治疗。治疗腰椎间盘突出症的手术方式有很多，传统开放手术具有创伤大、并发症多、易复发等缺点，微创技术具有创伤小、恢复快、并发症少等优点，使微创手术更受青睐。随着脊柱外科微创和内镜技术的发展，经皮椎间孔镜技术在临床上治疗腰椎间盘突出症越来越多，本文主要从经皮椎间孔镜的优势和适应证、操作技巧和注意事项、临床疗效和术后并发症等方面，阐述经皮椎间孔镜技术在腰椎间盘突出症治疗中的应用及进展 [关键词] 经皮椎间孔镜技术；腰椎间盘突出症；微创 [中图分类号] R681.5 [文献标识码] A [文章编号] 1673-7210（2016）11（b）-0034-04 [Abstract] Lumbar disc herniation is a common and frequently-occurring disease in the areas of orthopedics. In the majority， the symptoms of these patients after conservative treatment can be alleviated. Only about 10% of the patients eventually need operative treatment. The surgical treatment of lumbar disc herniation has a lot of methods. The traditional open operation has many defects， like serious trauma， more complication and high recurrence rate. On the contrary， minimally invasive technique has the advantages of small trauma， less complication as well as quickly recovery， and these merits make it more popular. With the development of the minimally invasive spine and endoscopic technology， percutaneous transforaminal endoscopic discectomy technology is extensively applied in the clinical treatment of lumbar disc herniation. This article mainly talks about the advantages， indications， operative skills and the points for attention， the clinical efficacy and postoperative complications of percutaneous transforaminal endoscopic discectomy and indications as well as its application and progress in the treatment of lumbar disc herniation. [Key words] Percutaneous transforaminal endoscopic discectomy； Lumbar disc herniation； Minimal invasion 腰椎间盘突出症（lumbar disc herniation，LDH）是骨科的常见病和多发病，是腰腿痛最常见的原因。本病多发于青壮年，男性较女性多见，这与劳动强度大及外伤有关。一般认为在20岁以后，椎间盘开始退变，髓核含水逐渐减少，椎间盘的弹性和抗负荷能力随之减弱，LDH就是在椎间盘退变的基础上发生的，而外伤则常为其发病的重要原因。L4/5及L5/S1是发病最高的节段，主要原因是腰骶部活动度大，处于活动的脊柱和固定的骨盆交界处，承受的压力最大，椎间盘容易发生退变及损伤。保守治疗和手术治疗是LDH的主要治疗方式，绝大多数的患者可经过保守治疗症状得以缓解，仅10%的患者经保守治疗无效后最终需要手术治疗。手术治疗包括传统的开放手术和微创手术，传统开放手术具有创伤大、术后恢复慢、并发症多及易复发等缺点；而微创手术具有创伤小、术后恢复快、并发