激光的种类
多种激光用于PLDD，主要使用的激光有：①Er:YAG激光，波长：2940nm。②CO2激光，10600nm。③Nd:YAG激光，波长：1064或1318nm。④Argon激光，波长488nm或514nm。⑤Ho：YAG激光，波长：2180nm。⑥准分子激光波长193nm。⑦KTP激光，532nm〔1〕。激光的选择依赖于光纤的传光能力：组织吸收/切除；热量的产生和传播。激光的特性特别重要，因为椎间盘无血管，是紧密组织并接近脊髓和神经组织〔4〕。在目前的实验研究中，由于使用条件不一样，各个激光系统汽化率不一样，其中Choy〔1，2〕对此作了较为详细的研究。他比较了多种不同激光波长对人尸椎间盘标本的汽化率，测得CO2，Er:YAG,Nd:YAG,Ho:YAG及Excimer的汽化率分别为0.23，0.20，0.16，0.13及0.08mg/J。虽然CO2和Er:YAG两种不同波长的激光对椎间盘汽化效应最好，但目前无相应的传播光纤，使其应用受到限制。Choy主张使用Nd:YAG进行PLDD为佳。新近使用的半导体激光(波长805nm)，不但具有良好的汽化切割、凝固功能，而且其透射深度仅1mm，对周围组织损伤甚微，从而使PLDD更加完美，几乎无并发症发生〔4，5〕。半导体激光优于CO2，Nd:YAG，KTP等激光。……
参考文献：
［1］Choy DS,Altman PA,Case RB,et al.Laser radiation at various wavelengths for decompression of intervertebral disk.Experimental observations on human autopsy specimens.Clin Orthop.1991 Jun(267):245-250
［2］Choy DS,Case RB,Fielding W,et al.Percutaneous laser nucleolysis of lumbar disks.N Eng1 J Med.1987 Sep 17;317(12):771-712
［3］Yonezawa T,Onomura T,Kosaka k,et al.The system and procedures of percuataneous intradiscal laser nucleotomy.Spine,1990;15(11):1175-1185
［4］Cangi A,Dietemann JL,Ide C,et al.Percutaneous laser disk decompression under CT and fluoroscopic guidance:indications,technique,and clinical experience.Radiographics,1996;16(1):89-96
［5］Siebert We,Berendse BT,Tollgaard J.Percutaneous laser disk decompression.Experience since 1989.Orthopade 1996;25(1):42-48
［6］Nerubay J,Caspi I,Levinkopf M,et al.Percutaneous laser nucleolysis of the intervertebral lumbar disc.An experimental study.Clin Orthop,1997;337(1):42-44
［7］Choy DS,Ascher-PW,Ranu-HS,et al.Percutaneous laser disc decompression.A new therapeutic modality.Spine.1992 aug;17(8):949-956
［8］Kuschera HP,Buchelt M,Lack W,et al.Circumferential measurement of anulus deviation after laser nucleotomy.Lasers Surg Med.1997;20(1):77-83
［9］Kutschera HP,Lack W,Buchelt M,et al.Comparative study of surface displacement in discs following chemonucleolysis and lasernucleotomy.Lasers Surg Med.1998;22(5):275-80
［10］Ohnmeiss DD,Guyer Rd,Hochschuler SH,et al.Laser disc decompression.The importance of proper patient selection.Spine.1994 Sep 15;19(18):2054-2059
［11］Steiner P,Zweifel K,Botnar R,et al.MR guidance of laser disc decompression:preliminary in vivo experience.Eur Radiol.1998;8(4):592-597
［12］Bosacco SJ,Bosacco DN,Berman AT,et al.Functional resuts of percutaneous laser discectomy.Am J Orthop,1996;25(12):825-828
［13］Lee SH,Lee SJ,Park KH,et al.Comparison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy.Orthopade 1996;25(1):49-55
［14］Cvitanic OA,Schimandle J,Casper GD,et al.subchondral marrow changes after laser diskectomy in the lumbar spine:MR imaging findings and clinical correlation.Am J Roentgenol.2000;174(5):1363-1369
［15］Epstein NE.Nerve root complications of percutaneous laser-assisted diskectomy performed at outside institutions:a technical note.J Spinal Disord 1994;7(6):510-512
［16］Epstein NE.Laser-assisted diskectomy performed by an internist resulting in cauda equina syndrome.J Spinal Disord,1999;12(1):77-79
