Yeung A T
Squaw Peak Surgical Facility, Phoenix, AZ, USA.
Mt Sinai J Med. 2000 Sep;67(4):327-32.
The author relates his 7 years' experience with endoscopic spine surgery for lumbar disc herniations and conditions previously treated only with more invasive methods.
Five hundred (500) patients were treated with the Yeung endoscopic spine system, which features an endoscope with a 2.8 mm operating channel. The protocol included preoperative or intraoperative discography in all cases. Adjuvant therapies were employed in various clinical conditions when dictated by the visualized spinal pathology--KTP laser (Laserscope, San Jose, CA) in 100 patients, radiofrequency by electrothermal probe in 400 patients, chymopapain in 50 cases, and intraoperative steroids in 100 cases. A newer slotted tube system allowed for foraminoplasty and removal of osteophytes or extruded fragments.
Good-to-excellent results were recorded in 432 of the 500 patients (86.4%). Separate analysis was made of the first 100 cases when the KTP laser was in use.
The 2.8 mm operating channel scope produced clear visualization of annular tears, disc fragments, foraminal osteophytes, and the epidural space. Monitoring of the microinstruments in the disc space and spinal canal was readily accomplished. The quality of the imaging provided by discography improved the definition of the disc pathology. Adjuvant use of lasers, radiofrequency, chymopapain, and intradiscal steroids and the newer slotted tube system, have contributed to the advances in minimally invasive technique for endoscopic discectomy.
作者阐述其7年使用内镜脊柱手术治疗腰椎间盘突出症及以往仅采用更具侵入性方法治疗的病症的经验。
500例患者接受了杨式内镜脊柱系统治疗，该系统配备一个带有2.8毫米操作通道的内镜。所有病例的治疗方案均包括术前或术中椎间盘造影。根据可视化的脊柱病变情况，在不同临床情形下采用辅助治疗——100例患者使用KTP激光（Laserscope，加利福尼亚州圣何塞），400例患者使用电热探头进行射频治疗，50例患者使用木瓜凝乳蛋白酶，100例患者术中使用类固醇。一种更新的开槽管系统可用于椎间孔成形术以及去除骨赘或突出的碎片。
500例患者中有432例（86.4%）取得了良好至优异的效果。对最初使用KTP激光的100例病例进行了单独分析。
2.8毫米操作通道的内镜能够清晰显示纤维环撕裂、椎间盘碎片、椎间孔骨赘和硬膜外间隙。能够轻松实现对椎间盘间隙和椎管内微型器械的监测。椎间盘造影提供的成像质量改善了椎间盘病变的清晰度。激光、射频、木瓜凝乳蛋白酶和椎间盘内类固醇的辅助使用以及更新的开槽管系统，推动了内镜下椎间盘切除术微创技术的进步。
