经皮椎间孔镜技术在腰椎退行性疾病治疗中的研究进展
Research Progress of Percutaneous Intervertebral Foraminoscopy Technology in the Treatment of Lumbar Degenerative Diseases
DOI: 10.12677/acm.2025.151231, PDF,   
作者: 肖毅辉：赣南医科大学第一临床医学院，江西 赣州；罗嘉全：赣南医科大学第一附属医院脊柱外科，江西 赣州
关键词: 经皮椎间孔镜技术；腰椎退行性疾病；微创手术；临床效果；Percutaneous Endoscopic Intervertebral Foramen Technology； Lumbar Degenerative Diseases； Minimally Invasive Surgery； Clinical Outcomes
摘要: 随着我国社会经济水平的发展以及人口结构趋向老龄化，中老年人腰椎退行性病患者也日益增多，腰椎退行性疾病的发病率逐年上升，给患者的生活质量带来了显著影响。传统的开放手术治疗方法虽然有效，但往往伴随较大的创伤和恢复期，限制了其在广泛人群中的应用，并且绝大多数患者更倾向于通过微创技术解决问题。近年来经皮椎间孔镜技术(Percutaneous Endoscopic Discectomy, PELD)已成为治疗腰椎退行性疾病的有效手术方法之一，作为一种微创外科手术手段，以其创伤小、恢复快和疼痛少等优点，在腰椎退行性疾病的治疗中得到了广泛关注。尽管该技术在临床应用中展现出良好的前景，但仍存在适应症选择、手术技术熟练度、临床效果及并发症管理等方面的问题。本文旨在综述经皮椎间孔镜技术在腰椎退行性疾病中的最新研究进展，深入分析其适应症、手术技术、临床效果及并发症管理等关键内容，以期为今后的临床应用提供参考和指导。
Abstract: With the development of our country’s social and economic level and the aging population structure, the number of middle-aged and elderly patients with lumbar degenerative diseases is also increasing. The incidence of lumbar degenerative diseases is rising year by year, significantly affecting the quality of life of patients. Although traditional open surgical treatment methods are effective, they often come with considerable trauma and recovery time, limiting their application in a wide population, and most patients prefer to solve problems through minimally invasive techniques. In recent years, percutaneous endoscopic discectomy (PELD) has become one of the effective surgical methods for treating lumbar degenerative diseases. As a minimally invasive surgical approach, it has gained widespread attention in the treatment of lumbar degenerative diseases due to its advantages of minimal trauma, quick recovery, and less pain. Despite the promising prospects of this technology in clinical applications, there are still issues regarding the selection of indications, surgical skill proficiency, clinical outcomes, and management of complications. This article aims to review the latest research progress of percutaneous endoscopic discectomy technology in lumbar degenerative diseases, analyzing key aspects such as indications, surgical techniques, clinical outcomes, and management of complications, in order to provide reference and guidance for future clinical applications.
文章引用：肖毅辉, 罗嘉全. 经皮椎间孔镜技术在腰椎退行性疾病治疗中的研究进展[J]. 临床医学进展, 2025, 15(1): 1731-1738. https://doi.org/10.12677/acm.2025.151231

参考文献

[1] Urban, J.P.G. and Fairbank, J.C.T. (2020) Current Perspectives on the Role of Biomechanical Loading and Genetics in Development of Disc Degeneration and Low Back Pain: A Narrative Review. Journal of Biomechanics, 102, Article ID: 109573. [Google Scholar] [CrossRef] [PubMed]
[2] Davies, M.R., Kaur, G., Liu, X., Alvarado, F.G., Nuthalapati, P., Liu, M., et al. (2021) Paraspinal Muscle Degeneration and Regenerative Potential in a Murine Model of Lumbar Disc Injury. North American Spine Society Journal (NASSJ), 6, Article ID: 100061. [Google Scholar] [CrossRef] [PubMed]
[3] Saremi, A., Goyal, K.K., Benzel, E.C. and Orr, R.D. (2024) Evolution of Lumbar Degenerative Spondylolisthesis with Key Radiographic Features. The Spine Journal, 24, 989-1000. [Google Scholar] [CrossRef] [PubMed]
[4] Ito, Z., Imagama, S., Kanemura, T., Satake, K., Ando, K., Kobayashi, K., et al. (2014) Volumetric Change in Interbody Bone Graft after Posterior Lumbar Interbody Fusion (PLIF): A Prospective Study. European Spine Journal, 23, 2144-2149. [Google Scholar] [CrossRef] [PubMed]
[5] Huang, W., Han, Z., Liu, J., Yu, L. and Yu, X. (2016) Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine, 95, e2378. [Google Scholar] [CrossRef] [PubMed]
[6] Uchikado, H., Nishimura, Y., Hattori, G. and Ohara, Y. (2020) Micro-Anatomical Structures of the Lumbar Intervertebral Foramen for Full-Endoscopic Spine Surgery: Review of the Literatures. Journal of Spine Surgery, 6, 405-414. [Google Scholar] [CrossRef] [PubMed]
[7] Wang, R., Liang, Z.Y., Chen, X.Y. and Chen, C.M. (2021) Technical Tips for Percutaneous Transforaminal Endoscopic Discectomy: A Three‐Step Maneuver for Puncture and Early Clinical Experience. Orthopaedic Surgery, 14, 104-110. [Google Scholar] [CrossRef] [PubMed]
[8] Ju, C.I. and Lee, S.M. (2023) Complications and Management of Endoscopic Spinal Surgery. Neurospine, 20, 56-77. [Google Scholar] [CrossRef] [PubMed]
[9] Smith, L. (1964) Enzyme Dissolution of the Nucleus Pulposus in Humans. JAMA, 187, 137-140. [Google Scholar] [CrossRef] [PubMed]
[10] Kambin, P. and Zhou, L. (1996) History and Current Status of Percutaneous Arthroscopic Disc Surgery. Spine, 21, 57S-61S. [Google Scholar] [CrossRef] [PubMed]
[11] Yeung, A.T. (1999) Minimally Invasive Disc Surgery with the Yeung Endoscopic Spine System (YESS). Surgical Technology International, 8, 267-277.
[12] Hoogland, T., Schubert, M., Miklitz, B. and Ramirez, A. (2006) Transforaminal Posterolateral Endoscopic Discectomy with or without the Combination of a Low-Dose Chymopapain: A Prospective Randomized Study in 280 Consecutive Cases. Spine, 31, E890-E897. [Google Scholar] [CrossRef] [PubMed]
[13] Ahn, Y. (2019) Endoscopic Spine Discectomy: Indications and Outcomes. International Orthopaedics, 43, 909-916. [Google Scholar] [CrossRef] [PubMed]
[14] Fukuhara, D., Ono, K., Kenji, T. and Majima, T. (2022) A Narrative Review of Full-Endoscopic Lumbar Discectomy Using Interlaminar Approach. World Neurosurgery, 168, 324-332. [Google Scholar] [CrossRef] [PubMed]
[15] Kambin, P. (1991) Arthroscopic Microdiskectomy. The Mount Sinai Journal of Medicine, New York, 58, 159-164.
[16] Zhu, Y., Zhang, X., Gu, G., Fan, Y., Zhou, Z., Feng, C., et al. (2024) Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Assisted with Selective Nerve Root Block for Treating Radicular Pain with Diagnostic Uncertainty in the Elderly. Journal of Pain Research, 17, 753-759. [Google Scholar] [CrossRef] [PubMed]
[17] Meng, B. (2020) Percutaneous Endoscopic Lumbar Discectomy: Indications and Complications. Pain Physician, 1, 49-56. [Google Scholar] [CrossRef] 
[18] Bu, J., Lei, Y., Wang, Y., Zhao, J., Huang, S., Liang, J., et al. (2024) A Multi-Element Identification System Based on Deep Learning for the Visual Field of Percutaneous Endoscopic Spine Surgery. Indian Journal of Orthopaedics, 58, 587-597. [Google Scholar] [CrossRef] [PubMed]
[19] Meng, S., Peng, C., Zhou, C., Tao, H., Wang, C., Zhu, K., et al. (2021) Massively Prolapsed Intervertebral Disc Herniation with Interlaminar Endoscopic Spine System Delta Endoscope: A Case Series. World Journal of Clinical Cases, 9, 61-70. [Google Scholar] [CrossRef] [PubMed]
[20] Ahn, S., Kim, S., Kim, D. and Lee, B. (2016) Comparison of Outcomes of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Young Adults: A Retrospective Matched Cohort Study. World Neurosurgery, 86, 250-258. [Google Scholar] [CrossRef] [PubMed]
[21] Goel, A., Patil, A., Shah, A., Rai, S., Vutha, R., Ranjan, S., et al. (2019) Lumbar Radiculopathy: Outcome Analysis Following Treatment by Only Fixation—A Report of an Early Experience of 44 Cases. Journal of Craniovertebral Junction and Spine, 10, 203-209. [Google Scholar] [CrossRef] [PubMed]
[22] Lehnen, N.C., Haase, R., Faber, J., Rüber, T., Vatter, H., Radbruch, A., et al. (2021) Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study. Diagnostics, 11, Article 902. [Google Scholar] [CrossRef] [PubMed]
[23] Borshchenko, I., Gulzatyan, A., Kartavykh, R. and Grin, A. (2019) How I Do It: Bilateral Lumbar Spinal Canal Microsurgical Decompression via Unilateral Approach. Acta Neurochirurgica, 161, 2375-2380. [Google Scholar] [CrossRef] [PubMed]
[24] Bradley, R., Kumar, A. and Barrett, C. (2021) The Glasgow Lumbar Spinal Stenosis Scale: An Individualised Measurement Formula for the Radiological Assessment of Lumbar Spinal Stenosis. British Journal of Neurosurgery, 37, 63-66. [Google Scholar] [CrossRef] [PubMed]
[25] Kapetanakis, S., Floros, E. and Gkantsinikoudis, N. (2021) Extreme Cases in Percutaneous Transforaminal Endoscopic Surgery: Case Series and Brief Review of the Literature. British Journal of Neurosurgery, 38, 94-98. [Google Scholar] [CrossRef] [PubMed]
[26] Jiang, Q., Ding, Y., Lu, Z., Cui, H., Zhang, J., Fu, B., et al. (2021) Comparative Analysis of Non-Full and Full Endoscopic Spine Technique via Interlaminar Approach for the Treatment of Degenerative Lumbar Spinal Stenosis: A Retrospective, Single Institute, Propensity Score-Matched Study. Global Spine Journal, 13, 1509-1521. [Google Scholar] [CrossRef] [PubMed]
[27] Abbatematteo, J.M., Giraldo, J.P., Williams, G.P., Lee, J.J., DiDomenico, J.D., White, M.D., et al. (2024) Anatomical Reduction of Spondylolisthesis through Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw Fixation: An Intraoperative Technical Note. World Neurosurgery, 189, 70-76. [Google Scholar] [CrossRef] [PubMed]
[28] Mitha, R., Mahan, M.A., Patel, R.P., Colan, J.A., Leyendecker, J., Zaki, M.M., et al. (2024) Lumbar Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Spondylolisthesis. World Neurosurgery, 191, e644-e651. [Google Scholar] [CrossRef] [PubMed]
[29] Baştuğ, B.T. (2024) Exploring Variations in Lumbar Canal Width: An MRI Study on Asymptomatic Patients by Age and Gender. Journal of Clinical Medicine, 13, Article 6775. [Google Scholar] [CrossRef] [PubMed]
[30] Sąsiadek, M. and Jacków-Nowicka, J. (2023) Degenerative Disease of the Spine: How to Relate Clinical Symptoms to Radiological Findings. Advances in Clinical and Experimental Medicine, 33, 91-98. [Google Scholar] [CrossRef] [PubMed]
[31] Dammers, R. and Koehler, P.J. (2002) Lumbar Disc Herniation: Level Increases with Age. Surgical Neurology, 58, 209-212. [Google Scholar] [CrossRef] [PubMed]
[32] Mao, L., Zhu, B. and Wu, X. (2021) One‐Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double‐level Contiguous Adolescent Lumbar Disc Herniation. Orthopaedic Surgery, 13, 1532-1539. [Google Scholar] [CrossRef] [PubMed]
[33] Ozgen, S., Konya, D., Toktas, O.Z., Dagcinar, A. and Ozek, M.M. (2007) Lumbar Disc Herniation in Adolescence. Pediatric Neurosurgery, 43, 77-81. [Google Scholar] [CrossRef] [PubMed]
[34] Li, H., Jiang, C., Mu, X., Lan, W., Zhou, Y. and Li, C. (2018) Comparison of MED and PELD in the Treatment of Adolescent Lumbar Disc Herniation: A 5-Year Retrospective Follow-Up. World Neurosurgery, 112, e255-e260. [Google Scholar] [CrossRef] [PubMed]
[35] Mao, L., Wang, K., Zhu, W., Shen, Z., Zhang, X., Xie, Z., et al. (2024) Repeat Surgery after Percutaneous Endoscopic Lumbar Discectomy for Adolescent Lumbar Disc Herniation: A Multicenter Observational Study. Orthopaedic Surgery, 16, 1336-1343. [Google Scholar] [CrossRef] [PubMed]
[36] Lagerbäck, T., Möller, H. and Gerdhem, P. (2019) Lumbar Disc Herniation Surgery in Adolescents and Young Adults: A Long-Term Outcome Comparison. The Bone & Joint Journal, 101, 1534-1541. [Google Scholar] [CrossRef] [PubMed]
[37] Yin, G., Wang, C. and Liu, S.Q. (2021) Comparative Analysis of the Therapeutic Efficiency and Radiographic Measurement Between the Transforaminal Approach and Interlaminar Approach in Percutaneous Endoscopic Discectomy. Turkish Neurosurgery, 31, 857-865.
[38] Zhou, Y., Zhou, C., Li, Q., Cai, L., Kou, B., Fang, W., et al. (2024) Efficacy of PE-PLIF with a Novel ULBD Approach for Lumbar Degeneration Diseases: A Large-Channel Endoscopic Retrospective Study. Journal of Orthopaedic Surgery and Research, 19, Article No. 269. [Google Scholar] [CrossRef] [PubMed]
[39] Wu, B., Yang, L., Fu, C., Zhuo, Y., Feng, X. and Xiong, H. (2022) Global Trends and Hotspots in Endoscopic Discectomy: A Study Based on Bibliometric Analysis. Neurospine, 19, 1093-1107. [Google Scholar] [CrossRef] [PubMed]
[40] Barsa, P., Fröhlich, R., Adamík, J., et al. (2020) Surgical Treatment of Cervical Spine Fractures in Ankylosing Spondylitis Patients: Posterior Stabilization Using Intraoperative CT Scanner-Based Navigation. Rozhledy V Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti, 99, 212-218.
[41] Keister, A., Grossbach, A., Toop, N., Mallory, N., Gibbs, D., Xu, D., et al. (2022) Early Postural Stability Changes in Patients Undergoing Correction of Spinal Deformity: A Prospective, Controlled Pilot Study. Spine, 48, 240-246. [Google Scholar] [CrossRef] [PubMed]
[42] Shost, M.D., Jella, T.K., Ronald, A.A., Herring, E.Z., Sajatovic, M. and Smith, G.A. (2022) Clinical Utility of Routine Postoperative Imaging in Spinal Fusion Surgery: A Systematic Review. World Neurosurgery, 167, 222-228.e1. [Google Scholar] [CrossRef] [PubMed]

为你推荐