经皮椎间孔镜和椎间盘镜治疗腰椎间盘突出症和椎管狭窄症的选择与应用

摘要

经皮椎间孔镜和椎间盘镜是目前治疗腰椎间盘突出和椎管狭窄症的常用微创内镜技术。椎间盘镜经后路椎板间隙开窗，原理与传统开窗类似，适用于绝大多数腰椎间盘突出和椎管狭窄症，尤其可动式椎间盘镜更利于显露和操作。经皮椎间孔镜经椎间孔自然间隙、也可经椎板间隙入路，在生理盐水下操作，更加微创，但操作范围相对局限，需要精确穿刺，两者分别有独特的操作规范和技巧，适应证既有交叉，也有互补，可根据患者具体情况选择应用。%Nowadays, percutaneous transforaminal endoscopic discectomy (PTED) and microscopic endoscopic disecto⁃my (MED) are common techniques for lumbar disc herniation and stenosis. Similar to traditional fenestration, MED is per⁃formed via interlamina approach, and is suitable for most cases of lumbar disc herniation and stenosis. And the mobile MED (MMED) used by author is beneficial to expose and manipulation. The PTED is performed during normal saline irrigation via natural transforaminal or interlamina approach. Compared to MED, PTED is less invasive and has relatively limited operat⁃ing range, which depends on accurate puncture. MED and PTED have their particular standard and skills, and their indica⁃tion is crossed and complementary. These two techniques can be selected according to specific conditions of patients.