自锚式侧路腰椎椎体间融合术的设计与应用  

The design and application of self-anchored lateral lumbar interbody fusion

作　　者：徐宝山[1] 刘阳 姜洪丰[1] 刘越[1] 王涛[1] 黎宁[1] 许海委[1] 黄洪超[1] 吉宁[1] XU Bao-shan;LIU Yang;JIANG Hong-feng;LIU Yue;WANG Tao;LI Ning;XU Hai-wei;HUANG Hong-chao;JI Ning(Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin 300211, China)

机构地区：[1]天津医院微创脊柱外科

出　　处：《天津医药》2019年第9期937-942,共6页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目（31670983）

摘　　要：目的评估自锚式侧路腰椎椎间融合术(SA-LLIF)的价值和疗效,避免后路内固定,简化手术步骤。方法选择2019年3月-6月在我科手术治疗的腰椎退变性疾病患者11例,男3例,女8例,年龄55~76岁,均有腰腿痛,站立和活动时加重,卧床时症状减轻一半以上或消失,包括腰椎失稳7例,滑脱4例(Ⅰ度3例,Ⅱ度1例),其中2例伴有骨质疏松症,2例伴有脊柱侧凸,责任节段L2~31例、L3~44例、L4~54例、L2~41例、L3~51例。应用带锚定嵌片的零切迹融合器经斜侧入路行腰椎椎体间融合术,避免后路内固定。全麻后患者呈右侧卧位,经左侧小切口腹膜外入路显露腰大肌前缘,向后适度牵开腰大肌显露责任椎间隙左侧方,处理椎间隙后植入合适大小的填满异体骨的融合器,将远近侧两个锚定嵌片依次插入融合器和邻近椎体,锁定融合器和椎体,均未放置引流。记录患者术前、术中、术后有关参数,并进行随访。采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价临床疗效,X线片评估腰椎前凸角(LL)、椎间隙高度(DH)、滑脱率(S)、cage移位和下沉情况。结果 11例患者均顺利完成手术,手术时间65~110 min,平均(78.0±21.5)min,术中出血15~60 mL,平均(35.0±23.2)m L,均未发生神经、血管损伤等并发症。术后次日带腰围下地活动。VAS评分自术前(6.2±0.8)分降至(1.7±0.5)分,ODI评分自术前47.8%±14.9%降至术后11.2%±3.2%,差异均有统计学意义。术后X线片示脊柱序列恢复满意,内植物位置良好,LL自术前36.4°±10.2°恢复至术后48.0°±10.7°,DH自术前(8.3±2.5)mm恢复至(13.3±3.3)mm,S自术前26.7%±4.4%恢复至术后10.3%±5.3%,差异均有统计学意义。随访期间所有患者均未出现cage移位,1例肥胖患者融合器下沉约2 mm,其他患者均未出现融合器明显下沉。结论 SA-LLIF可以提供良好的即刻稳定性,避免后路内固定,操作简单,疗效优良。Objective To evaluate the value and efficacy of self-anchored lateral lumbar interbody fusion (SA-LLIF), avoid posterior internal fixation and simplify the surgical procedure. Methods Eleven patients with lumbar degenerative disease treated in our hospital from March to June 2019 were enrolled in this study, including 3 males and 8 females (aged 55-76 years). All patients had low back pain and leg pain, which aggravated when standing and moving and alleviated or disappeared when staying in bed. The imaging results revealed that there were 7 cases of lumbar instability, 4 cases of spondylolisthesis (grade Ⅰin 3 cases, grade Ⅱ in 1 case), 2 of them with scoliosis and 2 with osteoporosis. The fusion level included L2-3 in 1 case, L3-4 in 4 cases, L4-5 in 4 cases, L2-4 in 1 case and L3-5 in 1 case. Zero-profile self-anchored cage was used for lateral lumbar interbody fusion to avoid posterior internal fixation. After general anesthesia, the patient was in right decubitus position. The anterior edge of psoas major muscle was exposed through left small incision and extraperitoneal approach, the left side of the responsible intervertebral space was exposed by properly retracted psoas major muscle. After the intervertebral space was prepared, a suitable size of fusion cage filled with allograft was implanted. Two anchoring plates were inserted into the cage and the caudal and cephalic vertebral body, and the fusion cage was locked. The clinical efficacy was evaluated by visual analogue scale (VAS) and Oswestry dysfunction index (ODI). The lumbar lordosis (LL), disc height (DH), slippage rate (S) and sinking were evaluated by X-ray. Results The operation was performed successfully in all the 11 patients. The operation time was 65-110 minutes, with an average of (78.0±21.5) minutes. The intraoperative blood loss was 15-60 mL, with an average of (35.0±23.2) mL. No severe complication such as nerve or blood vessel injury was occurred. The patients were encouraged to ambulated next day after operation with soft brace. T

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 外科手术 微创性 侧方入路 

分 类 号：R681.5[医药卫生—骨科学]