三种微创技术在脊柱外科常见疾病中的应用

目的：正确选择微创技术治疗脊柱外科常见疾病，以最小的损伤，达到最佳的疗效。方法：选用自动经皮腰椎间盘切吸术（automated percutaneous lumbar diseectomy，APLD）治疗单纯腰椎间盘突出症（Lumbar disc herniation LDH）366例（配合同轴侧路镜下APLD18例）；用显微内镜下椎间盘切除术（mieroendoseopie diseectomy，MED）治疗伴有椎管狭窄、黄韧带肥厚及椎间盘钙化的LDH47例；用经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗骨质疏松性椎体压缩性骨折8例、推体转移瘤1例。结果：经APLD治疗组，1a随访优良率92％，5a随访优良率85％，10a随访优良率79％；经MED治疗组，获1-3a随访，优良率为98％；8例骨质疏松性椎体骨折和1例椎体转移瘤经PVP治疗，获1a随访，疼痛全部缓解，无并发症。结论：只要严格掌握适应症，正确选择合适的微创技术，可望获得安全、理想的临床疗效。

THE CHOICE OF THREE SURGERY APPLIED FOR SPINAL DISEASE

Objective:To introduce the choice of three minimal invasive surgery applied for spinal disease,try to achieve satisfactory results with minimal trauma.Methods:366 cases of simple Lumbar disc herniation(LDH) were treated with automated percutaneous lumbar discectomy(APLD),18 cases of them were by the help of microendoscope;47 cases of LDH were treated with microendoscopic discectomy(MED);8 cases of osteoporotic vertebral compression fracture and 1 case of metastasis were treated with percutaneous vertebroplasty(PVP).Results:In the group of APLD,the rate of excellent and good outcomes was 92%(follow-up of 1 years),85%(follow-up of 5 years) and 79%(follow-up of 10 years);In the group of MED,the rate of excellent and good outcomes was 98%(followed up from 1 year to 3 years);8 cases of osteoporotic vertebral compression fracture and 1 case of metastasis treated with PVP were followed up for 1 years,complete pain relief was achieved in all cases,and no complication occured.Conclusion:Safe and satisfactory clinical results could achieve as long as the surgical indication was mastered strictly and the minimal invasive surgery was choiced correctly.