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摘要 经皮内镜腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)是近年来新兴的一项脊柱微创手术方式。PELD相对于经典的开放手术来说具有创伤小、出血量低、手术时间短、并发症少、康复时间短等优点。目前PELD已成为许多脊柱外科医生治疗常见类型腰椎间盘突出症(lumbar disc herniation,LDH)的首选方案。重度向上脱垂型腰椎间盘突出症(severe upwardmigrated lumbar disc herniation,SUM-LDH)作为一种特殊类型的LDH,其特征为椎间盘组织脱垂进入椎管后,常远离椎间盘平面,并进一步向头侧游离,通常位于出行神经根下方和硬膜囊前外侧间隙。此类疾病一度被认为是PELD治疗的禁忌证。近年来,随着科技的发展以及各国学者的探索,脊柱内镜技术进展迅速,手术技巧日益完善,PELD的手术适应证也在不断扩大,即使对于重度和极度困难的LDH病例也可以经PELD治疗,并且逐渐应用于SUM-LDH的治疗中。SUM-LDH患者术中取出的椎间盘组织往往不只有髓核,还混杂着破碎的终板。因此,如何准确定位穿刺靶点并确保把突出的椎间盘组织完全清除是治疗这一特殊类型LDH的重中之重。现将近年来经皮脊柱内镜治疗SUM-LDH的手术入路及其治疗进展等方面的相关研究进行综述。
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通讯作者:
隋国侠
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作者简介: 陈万森(1994- ),男,研究生在读,潍坊医学院,1406279220@qq.com。 |
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