摘要
目的对传统的经椎间孔腰椎椎体间融合术（TLIF）进行改良并探讨其临床意义。方法在12具新鲜成人尸体上完成传统后路腰椎椎体间融合（PLIF）和TLIF术式，扩大解剖显露周围结构，根据解剖学研究发现提出改良TLIF手术方式，并在12具新鲜尸体上操作、完成该术式，对其可行性及潜在优势进行分析。结果前期的解剖学研究发现传统PLIF和TLIF手术在行椎间融合时相应神经根张力较高，存在一定的损伤风险，同时发现在一侧上关节突与棘突及棘间韧带等中间结构之间存在一定的可操作区域。提出了将PLIF工作区域外移，TLIF工作区域内移的改良TLIF手术入路，即：采取后正中入路，保留棘突、椎板上缘、棘上、棘间韧带等后结构，剥离双侧椎旁肌，暴露椎板及关节突关节，不暴露横突，切除一侧下关节突及椎板下2／3（暴露上关节突关节面），单侧斜向处理椎间隙而行椎体间融合。在12具新鲜成人尸体上顺利模拟完成了改良TLIF手术，结果显示该术式具有以下优势：（1）不必暴露横突，保留棘突、椎板上缘、棘上、棘间韧带等后结构，仅咬除一侧下关节突及椎板下2／3；（2）中央管及术侧侧隐窝及神经根管可同时有效减压；（3）斜向处理目标椎间隙，后正中结构的保留有效地限制了对硬膜囊及下位神经根的牵拉，术中无需暴露上位神经根，不易损伤上位神经根。结论改良TLIF手术入路安全可行，理论上可以有效地降低神经根损伤的发生率，对于绝大多数国人腰椎疾患患者可能是一个较理想的选择。
Objective To put some improvements to the traditional transforaminal lumbar interbody fusion （TLIF） and discuss its clinical significance. Methods Completed the traditional posterior lumbar interbody fusion （PLIF） and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to the anatomical findings. And simulated the operation in 12 fresh cadavers, analyzed its feasibility and potential advantages. Results The early anatomical study found that the related nerve root was in a state of high tension and certain risk of injury when completed the traditional PLIF and TLIF surgery, and found certain operational area between the superior articular process and the midline structures of the spinous processes and interspinous ligaments. Put the modified TLIF surgical approach according to the anatomical findings, which the operating area is located in PLIF outside and TLIF inside. As the following words： Take a posterior- middle incision, preserve the supraspinous and interspinous ligaments, and the spinous processes, dissect the bilateral paravertebral muscle, expose lamina and facet joints, not including transverse process, and remove unilateral inferior two third lamina, inferior articular process and expose the articular surface of the superior articular process, then dispose the intervertebral space for interbody fusion obliquely in the unilateral approach. Successfully completed the modified TLIF procedure in 12 fresh cadavers, the results showed that the technique has the following advantages. （ 1 ） Only remove unilateral inferior two third lamina and inferior articular process, preserve the supraspinous and interspinous ligaments, and the spinous processes, not expose the transverse process. （2） Both central canal, and lateral recess and nerve root canal of the operative side can be decompressed effectively simultaneously. （3） Avoid excessive traction to the thecal sae and traversing nerve roots and decr
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第14期1100-1103,共4页
Chinese Journal of Surgery
关键词
腰椎
脊柱融合术
解剖学
Lumbar vertebrae
Spinal fusion
Anatomy
