摘要
对脊柱后方韧带结构复合体(posterior ligamentous complex,PLC)重要性的认识逐渐加深,传统后方入路及内固定的并发症日益凸显,以更小的创伤实现减压和固定成为当下脊柱外科的重要研究内容。腰椎斜外侧入路椎间融合术(oblique lateral interbody fusion,OLIF)对Ⅰ/Ⅱ度的腰椎滑脱、轻度的椎管狭窄及退变性侧弯有较好疗效。但是OLIF手术的明显不足是无法对椎管实现良好减压。黄韧带和关节突的增生肥厚是引起椎管狭窄的重要原因,但这些结构退变可以增加脊柱的稳定性。鉴于只有同时存在两种或以上解剖因素才能引起腰椎管狭窄症(lumbar canal stenosis,LSS),因此解除任何一个方向的压迫,便可达得神经减压的效果。基于上述理论,我们对3例LSS病人借助脊柱内窥镜和带角度的磨钻,采用腰椎斜外侧入路在可视下去除椎管前方的椎间盘和增生的骨赘,扩大了椎管容积,获得了和后方去除致压因素等同的减压效果。本文对此术式的理论和技术进行探讨。
Understanding of the importance of posterior ligamentous complex(PLC) has gradually deepened.Complications of traditional posterior approach and internal fixation have become increasingly apparent.Decompression and stabilization with less trauma has becomea popular research area in spinal surgery.Oblique lateral interbody fusion(OLIF) performed well on lumbar spondylolisthesis of Ⅰ/Ⅱ degree,mild spinal stenosis and degenerative scoliosis.However,an obvious disadvantage of OLIF is that it cannot achieve satisfactory decompression of the spinal canal.Although hypertrophy of the ligamentum flavum and articular processes are important factors of spinal stenosis,these structural changes are responsive to spinal degenerations and can increase spinal stability.Only two or more anatomical factors at the same time can cause LSS,and nerve decompression can be achieved after removing compressive factors in any direction.Based on the above theory,we reviewed three cases diagnosed with LSS and decompressed with usage of spinal endoscopes and angled drills,and discs and posterior osteophytes were removed through the oblique lateral approach.This article discusses the theory and techniques of this surgery.
作者
杜传超
毛天立
刘宇
贾斐
海宝
潘晓宇
刘晓光
DU Chuanchao;MAO Tianli;LIU Yu(Department of Orthopedics,Peking University Third Hospital,Beijing 110191,China)
出处
《临床外科杂志》
2020年第12期1188-1191,共4页
Journal of Clinical Surgery
关键词
椎管减压
脊柱内窥镜
椎间融合
腰椎斜外侧入路
canal decompression
spinal endoscopes
intervertebral fusion
lumbar oblique lateral approach
