斜外侧椎间融合技术的研究进展  

Advances in oblique lateral interbody fusion

作　　者：钟华璋 田大胜[1] 周云[1] 钱军 荆珏华[1] 

机构地区：[1]安徽医科大学第二附属医院骨科,合肥230601

出　　处：《中华骨科杂志》2018年第1期46-52,共7页Chinese Journal of Orthopaedics

基　　金：2016年安徽省卫生和计划生育委员会科研计划项目（2016QK053）

摘　　要：斜外侧椎间融合术（oblique lateral interbody fusion, OLIF）是目前脊柱外科领域开展的一项新技术。该技术是从前侧方斜行在腹膜后经腰大肌与腹部大血管鞘之间的自然间隙建立直视椎间隙的工作通道，完成前中柱的椎间融合，恢复椎间隙及椎间孔的高度，间接减压狭窄的椎管或神经根管，适用于退变性腰椎疾患、脊柱结核、肿瘤、侧后凸畸形、术后翻修、创伤骨折等情况。OLIF具有手术创伤小、术中出血少、住院时间短、康复过程快等优点，并且腹膜后入路可避免损伤腹腔内脏器，不进入椎管则不会刺激椎管内神经，经腰大肌前方间隙则较少破坏腰大肌及腰骶丛等。OLIF虽在理论上具有巨大优势，但术后屈髋无力、腹股沟区疼痛麻木、对侧神经损伤等并发症仍屡见报道。这考虑与术中为建立工作通道长时间牵拉损伤腰大肌及其深面的腰骶丛、宽大的融合器植入损伤对侧神经根等有关，究其根本原因在于术者一味追求新技术，而对新技术本身及其适应证、禁忌证、工作通道毗邻范围内的解剖、手术操作细节等方面缺乏足够认识，导致与技术或入路等相关的并发症发生。如何更好地了解OLIF操作流程，掌握局部解剖层次，把握手术适应证与禁忌证等对成功应用OLIF技术治疗各种腰椎疾患至关重要。Oblique lateral interbody fusion （OLIF） is a new technique in spine surgery, through oblique lateral retroperito-neal approach, it can establish a work corridor direct access to the intervertebral space between the psoas muscles and the abdominal vessels sheath. Through the retroperitoneal work corridor, OLIF can complete intervertebral fusion of anterior and middle col- umn, restore the height of intervertebral space and foramen, and make the spinal eanal or nerve root indirect-decompression. OLIF is applicable to degenerative lumbar spine diseases, spinal tuberculosis, tumor, kyphosis, postoperative renovation, trauma, etc. OLIF conforms to the current trend of minimally invasive spinal surgery, which has many advantages like less surgical trauma, less surgical bleeding loss, shorter hospital stay, faster recovery, less damage to the abdominal organs, no stimulation of the spinal nerve, and less damage to the psoas and lumbosacral plexus. Although OLIF has theoretically great advantages, the postoperative hip flexion weakness, the groin and thigh area pain and numbness, contralateral nerve injury and other complications are often re- ported, notwithstanding the complications are considered to be related to long time psoas compression which results in the psoas and lumbosacral plexus injury, large fusion device implantation which leads to contralateral nerve root injury and so on. The prima- ry cause is that the surgeon blindly pursues new technology with lack of knowledge about the new technology, as well as indications and contraindications, the anatomy of the working area, the details of the surgical operation, etc, causing complications asso- ciated with technology or access. Further understanding of the OLIF operation process, including mastering the local anatomy and grasping the surgical indications and contraindications is essential for successful application of OLIF technology to treat various lumbar disorders.

关 键 词：椎间融合技术 外侧 腹膜后入路 手术适应证 工作通道 神经根管 神经损伤 腰椎疾患 

分 类 号：R687.3[医药卫生—骨科学]