颈椎间盘突出症的微创治疗：后路内镜技术 临床应用进展

Minimally Invasive Treatment of Cervical Intervertebral Disc Protrusion: Clinical Application Progress of Posterior Endoscopic Techniques

摘要: 后路微创技术已成为治疗颈椎间盘突出症的重要方式，其中主要包括两种代表性术式：经皮后路内镜下颈椎间盘切除术(posterior percutaneous endoscopic cervical foraminotomy and discectomy, P-PECD)以及经皮后路单侧双通道内镜下颈椎间盘突出摘除术(UBE-posterior percutaneous endoscopic cervical discectomy, UBE-PCD)。P-PECD是一种以微创为特点的脊柱外科技术，尤其适用于神经根型颈椎病(CSR)的外科干预。相较于传统前路手术需经颈前重要组织结构，其避免了食管、气管、喉返神经损伤及椎体融合相关并发症。其具有组织创伤小、出血少、住院时间短、保留颈椎运动功能等明显优势。近年来，P-PECD、UBE-PCD在技术、器械及临床应用方面取得飞速进展。技术层面上，手术入路与解剖研究持续优化，从早期“经椎板间隙入路”到更精准的“Key-Hole”椎间孔成形技术、结合术中影像学定位与神经电生理功能监测，再次提升了神经减压的精确性与安全性。器械方面，内镜系统向更细直径、更高分辨率及更大操作通道发展，配套的镜下高速磨钻、钬激光、射频电极等工具在处理骨性增生和止血上更为高效。临床应用拓展上，其适应症得到进一步延伸，从单纯的软性突出到部分包含钙化或后纵韧带骨化的病例，甚至可以应用于颈椎后纵韧带骨化症单节段减压。

Abstract: Posterior minimally invasive techniques have become an important approach for treating cervical intervertebral disc protrusion, mainly including two representative surgical methods: posterior percutaneous endoscopic cervical foraminotomy and discectomy (P-PECD) and UBE-posterior percutaneous endoscopic cervical discectomy (UBE-PCD). P-PECD is a spinal surgical technique characterized by minimally invasive surgery, especially suitable for surgical intervention of cervical spondylotic radiculopathy (CSR). Compared with traditional anterior surgery that requires passing through important anterior cervical tissue structures, it avoids esophageal, tracheal, and recurrent laryngeal nerve injury and complications related to vertebral fusion. It has obvious advantages such as small tissue trauma, less bleeding, short hospital stay and preservation of cervical vertebrae motor function. In recent years, P-PECD and UBE-PCD have made rapid progress in technology, equipment and clinical application. From a technical perspective, the surgical approach and anatomical research have been continuously optimized. From the early “translaminal space approach” to the more precise “Key-Hole” intervertebral foramen shaping technique, combined with intraoperative imaging localization and neuroelectrophysiological function monitoring, the accuracy and safety of nerve decompression have been further enhanced. In terms of equipment, endoscopic systems are evolving towards finer diameters, higher resolutions and larger operation channels. The accompanying high-speed grinding drills, holmium lasers, radiofrequency electrodes and other tools under the microscope are more efficient in treating bony hyperplasia and hemostasis. In terms of clinical application expansion, its indications have been further extended, from simple soft protrusion to some cases involving calcification or ossification of the posterior longitudinal ligament, and it can even be applied to single-segment decompression for ossification of the posterior longitudinal ligament of the cervical spine.