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摘要 椎体间融合术(lumbar interbody fusion,LIF)是治疗一系列脊柱退变性疾病的一种常用的治疗方式。目前最常用的两种传统LIF手术方式是:经后路椎体间融合术(posterior lumbar interbody fusion,PLIF)和经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)。然而这两种手术方式均存在不少的并发症和风险,比如后方韧带复合体结构的破坏、潜在的神经根损伤、硬脊膜撕裂和硬膜外纤维化等。
近20年来,脊柱外科医师发现这些并发症给患者带来了越来越多的痛苦。为了避免这些问题的发生,出现了多种创新性的前外侧入路手术技术。这些新技术与传统手术相比有很多自己的优势:第一,避免对脊柱后柱结构的破坏,减轻患者痛苦,加快了康复速度;第二,大大缩短了手术时间,减少出血;第三,同样可以很好的完成神经根间接减压;最后,将椎间融合器的尺寸最大化,提高椎间融合率,从而更好地恢复脊柱前凸。目前应用范围较广的三种前外侧入路手术方式为:经前路椎体间融合术(anterior lumbar interbody fusion,ALIF)、经侧路椎体间融合术(lateral lumbar interbody fusion,LLIF)和经侧前方入路椎体间融合术(oblique lumbar interbody fusion,OLIF)。本文旨在对三种创新性手术方式进行综述,并通过对比明确三种手术方式各自的适用范围、解剖入路方式、手术风险等。
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通讯作者:
刘鹏
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作者简介: 靳宇飞(1985- ),男,主治医师,陆军特色医学中心脊柱外科,400042。 |
[1]Kim JE,Choi DJ.Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy[J].Clin Orthop Surg,2018,10(2):248-252.
[2]Watkins RT,Hanna R,Chang D,et al.Sagittal alignment after lumbar interbody fusion:comparing anterior,lateral,and transforaminal approaches[J].J Spinal Disord Tech,2014,27(5):253-256.
[3]Jackson KL,Yeoman C,Chung WM,et al.Anterior lumbar interbody fusion:two-year results with a modular interbody device[J].Asian Spine J,2014,8(5):591-598.
[4]Teng I,Han J,Phan K,et al.A meta-analysis comparing ALIF,PLIF,TLIF and LLIF[J].J Clin Neurosci.,2017(44):11-17.
[5]Wu AM,Hu ZC,Li XB,et al.Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis:minimum two-year follow up[J].Ann Transl Med,2018,6(6):105.
[6]Quraishi NA,Konig M,Booker S J,et al.Access related complications in anterior lumbar surgery performed by spinal surgeons[J].Eur Spine J,2013,22 (Suppl 1):S16-S20.
[7]Escobar E,Transfeldt E,Garvey T,et al.Video-assisted versus open anterior lumbar spine fusion surgery:a comparison of four techniques and complications in 135 patients[J].Spine (Phila Pa 1976),2003,28(7):729-732.
[8]Ozgur BM,Aryan HE,Pimenta L,et al.Extreme lateral interbody fusion (XLIF):a novel surgical technique for anterior lumbar interbody fusion[J].Spine J,2006,6(4):435-443.
[9]Attenello J,Chang C,Lee Y P,et al.Comparison of lateral lumbar interbody fusion (LLIF) with open versus percutaneous screw fixation for adult degenerative scoliosis[J].J Orthop.,2018,15(2):486-489.
[10]Berjano P,Langella F,Damilano M,et al.Fusion rate following extreme lateral lumbar interbody fusion[J].Eur Spine J,2015,24 (Suppl 3):369-371.
[11]Balsano M,Carlucci S,Ose M,et al.A case report of a rare complication of bowel perforation in extreme lateral interbody fusion[J].Eur Spine J,2015,24 (Suppl 3):405-408.
[12]Kueper J,Fantini GA,Walker BR,et al.Incidence of vascular complications during lateral lumbar interbody fusion:an examination of the mini-open access technique[J].Eur Spine J,2015,24(4):800-809.
[13]Rutter G,Phan K,Smith A,et al.Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion:a cadaver study[J].J Spine Surg,2017,3(3):419-425.
[14]Mehren C,Mayer HM,Zandanell C,et al.The Oblique anterolateral approach to the lumbar spine provides access to the lumbar spine with few early complications[J].Clin Orthop Relat Res,2016,474(9):2020-2027.
[15]Li JX,PhanK,Mobbs R.Oblique lumbar interbody fusion:technical aspects,operative outcomes,and complications[J].World Neurosurg,2017(98):113-123.
[16]Fujibayashi S,Hynes RA,Otsuki B,et al.Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease[J].Spine (Phila Pa 1976),2015,40(3):E175-E182.
[17]Digiorgio AM,Edwards CS,Virk MS,et al.Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion:technical note and case series[J].Neurosurg Focus,2017,43(2):E14.
[18]Ohtori S,Mannoji C,Orita S,et al.Mini-open anterior retroperitoneal lumbar interbody fusion:oblique lateral interbody fusion for degenerated lumbar spinal kyphoscoliosis[J].Asian Spine J,2015,9(4):565-572.
[19]Rao PJ,Maharaj MM,Phan K,et al.Indirect foraminal decompression after anterior lumbar interbody fusion:a prospective radiographic study using a new pedicle-to-pedicle technique[J].Spine J,2015,15(5):817-824.
[20]Oliveira L,Marchi L,Coutinho E,et al.A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements[J].Spine (Phila Pa 1976),2010,35(26 Suppl):S331-S337.
[21]Sato J,Ohtori S,Orita S,et al.Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion:oblique lateral interbody fusion for degenerated lumbar spondylolisthesis[J].Eur Spine J,2017,26(3):671-678.
[22]Rao PJ,Phan K,Giang G,et al.Subsidence following anterior lumbar interbody fusion (ALIF):a prospective study[J].J Spine Surg,2017,3(2):168-175.
[23]Marchi L,Abdala N,Oliveira L,et al.Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion[J].J Neurosurg Spine,2013,19(1):110-118.
[24]Abe K,Orita S,Mannoji C,et al.Perioperative complications in 155 Patients who underwent oblique lateral interbody fusion surgery:Perspectives and indications from a retrospective,multicenter survey[J].Spine (Phila Pa 1976),2017,42(1):55-62. |
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