脊柱内镜治疗退行性腰椎管狭窄症的技术进展与临床应用

Technical Progress and Clinical Application of Spinal Endoscopy in the Treatment of Degenerative Lumbar Spinal Stenosis

摘要: 退行性腰椎管狭窄症(Degenerative Lumbar Spinal Stenosis, DLSS)是一种常见的脊柱退行性疾病，好发于中老年人群。其主要病理改变包括黄韧带肥厚、关节突关节增生及椎间盘突出等，这些因素共同导致椎管有效容积减少，进而压迫马尾神经和神经根，引发神经源性间歇性跛行及相关神经功能障碍。虽然传统开放手术疗效明确，但存在组织创伤大、术后恢复慢、手术效果不佳等问题。近年来，以脊柱内镜技术为代表的微创术式在DLSS治疗中日益重要。本文系统综述了当前广泛应用的几种脊柱内镜术式，包括椎间盘镜(MED)、单轴脊柱内镜(UES)、单侧双通道内镜(UBE)及单孔分体内镜(OSE)，并分析其技术特点、适应症与临床疗效。研究显示，脊柱内镜手术在术中失血量、住院时间和术后功能恢复等围手术期指标上优于传统开放手术，且远期疗效相当。文中还探讨了硬脊膜撕裂、神经根损伤、硬膜外血肿及术后感染等常见并发症的预防与处理措施，强调精细解剖操作和实时神经功能监测对保障手术安全的关键作用。未来，脊柱内镜技术有望进一步融合影像导航、人工智能及新型手术器械，向更精准、微创和个体化方向发展，为DLSS患者提供更优治疗方案。

Abstract: Degenerative Lumbar Spinal Stenosis (DLSS) is a common spinal degenerative disease, which is prone to occur in middle-aged and elderly people. The main pathological changes include thickening of the ligamentum flavum, hyperplasia of the facet joints and intervertebral disc protrusion, etc. These factors jointly lead to a reduction in the effective volume of the spinal canal, which in turn compresses the cauda equina nerve and nerve roots, causing neurogenic intermittent claudication and related neurological dysfunction. Although traditional open surgery has definite therapeutic effects, it has problems such as large tissue trauma, slow postoperative recovery and poor surgical outcomes. In recent years, minimally invasive surgical methods represented by spinal endoscopy have become increasingly important in the treatment of DLSS. This article systematically reviews several widely used spinal endoscopic procedures at present, including discoscopy (MED), uniaxial spinal endoscopy (UES), unilateral dual-channel endoscopy (UBE), and single-port split endoscopy (OSE), and analyzes their technical characteristics, indications, and clinical efficacy. Studies have shown that spinal endoscopic surgery is superior to traditional open surgery in perioperative indicators such as intraoperative blood loss, hospital stay and postoperative functional recovery, and the long-term efficacy is comparable. The article also discusses the prevention and treatment measures of common complications such as dural tear, nerve root injury, epidural hematoma and postoperative infection, emphasizing the key role of precise anatomical operation and real-time neurological function monitoring in ensuring surgical safety. In the future, spinal endoscopy technology is expected to further integrate image navigation, artificial intelligence and new surgical instruments, developing towards greater precision, minimally invasive and individualized directions, providing better treatment options for patients with DLSS.