单孔分体内镜技术在脊柱退行性疾病治疗中的应用进展

Abstract

单孔分体内镜技术采用单一切口内的分体式通道设计，使皮肤创伤与器械自由度相分离；已有研究表明，该技术用于治疗腰椎间盘突出症和腰椎管狭窄症的短期疗效与单侧双通道内镜以及显微镜下的椎间盘切除术相似，差异集中在切口更短、术中出血更少、术后早期恢复更快等围手术期指标上，远期结局的差异尚不明确。有限元分析认为关节突关节切除不超过内侧三分之一即可保持腰椎稳定，在临床上切除量的控制受限于术者的经验或操作条件。单通道结构在进行止血时会受到视野遮挡的限制，并且迟发性硬膜外血肿等并发症风险尚未量化。目前所有文献均是单中心回顾性的研究，循证等级停留在四级，颈椎领域完全没有相关报道，学习曲线和并发症谱也缺乏量化分析。对于脊柱微创手术而言，该技术的意义在于弥补了经皮内镜与双通道内镜之间存在的空缺，是否具有临床增量由术者对软组织保护需求决定。今后的研究应该首先考虑颈椎方面的前瞻性研究和以并发症非劣效性为目标的随机对照试验。

Keywords

• 单孔分体内镜；脊柱退行性疾病；腰椎间盘突出症；腰椎管狭窄症；微创手术

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