经皮内镜椎板间入路腰椎间盘切除术

Kambin 及 Gellman [1]在1973年首次报道使用脊柱内镜，经皮从后外侧入路摘除压迫神经的椎间盘髓核组织。Yeung [2]发明了 YESS 系统，经后外侧椎间孔入路切除椎间盘髓核组织，成为最早的经皮内镜腰椎间盘切除术（ percutaneous endoscopic lumbar discectomy，PELD ）。YESS （ yeung endoscopic spine system ）脊柱内镜系统的发明及其相应的 YESS 技术为现代经皮腰椎内镜技术的发展奠定了基础。Ruetten 等[3]和 Hoogland 等[4]对 YESS 技术做出了改进，并由此发展为完全内镜技术（ full-endoscopic technique ）及 TESSYS 系统（ transforaminal endoscopic surgical system ）。PELD 以其创伤小，出血少，恢复快等优点，为椎间盘突出患者带来了福音。其微创性、有效性及良好的卫生经济学价值已被国内外众多从事脊柱内镜的学者证实[5]。常使用的是经皮内镜椎间孔入路腰椎间盘切除术（ percutaneous endoscopic transforaminal discectomy， PETD ），其适应证包括旁中央型、椎间孔型、极外侧型椎间盘突出症。但在经椎间孔入路治疗L5～S1椎间盘突出，尤其是脱垂型及腋下型突出时，高髂嵴、肥大翼化的 L5横突、椎间孔骨性周界的阻挡、背根神经节及由椎间孔出行的神经根限制了工作管道的充分移动，致摘除突出的髓核组织非常困难。为了避免PETD摘除椎间盘髓核组织时遇到的困难，Ruetten 采用经皮内镜椎板间入路腰椎间盘切除术（ percutaneous endoscopic interlaminar discectomy，＆amp;nbsp；PEID ）摘除突出的椎间盘髓核组织[6]。PEID具有手术入路解剖为脊柱外科医生熟悉，术中透视少，不受高髂嵴、椎间孔周界、背根神经节及出行神经根限制等优点[7]，其与PETD一起进一步扩大了经皮内镜的手术适应范围。

Percutaneous endoscopic interlaminar discectomy

With the development and evolution of percutaneous lumbar endoscopic techniques in recent 2 decades, more and more lumbar spine disorders can be solved with minimally invasive spine surgery. Compared with open surgery, percutaneous endoscopic lumbar discectomy （ PELD ） has advantages of less trauma, little impact on the stability of spine and rapid recovery. PELD can be divided into 2 types according to different approaches, percutaneous endoscopic interlaminar discectomy （ PEID ） and percutaneous endoscopic transforaminal discectomy （ PETD ）. As an important part of PELD, PEID is especially suitable for L5/S1 lumbar disc herniation in spite of migrated hemiated fragment, small intervertebral foramen and high iliac crest. The paper summaries advantages and disadvantages, indications, operative techniques, clinical effects, complications and preventive measures of PEID.