摘要
邻近节段退变(adjacent segment degeneration,ASDeg)是腰椎融合术后的常见并发症之一,其主要表现为邻近椎间盘突出、邻近椎体骨折或滑脱、邻近节段侧凸畸形、椎管狭窄或关节突关节退变等。当具有影像学ASDeg表现的患者出现腰骶痛、根性下肢痛或间歇性跛行等临床症状时,则称为邻近节段疾病(adjacent segment disease,ASDis),此时往往需要再手术治疗。目前开放术式已广泛应用于ASDis的治疗,包括经后路融合术及经椎间孔入路融合术等,传统手术疗效显著,但其始终存在手术创伤大、术中失血多、手术时间和住院时间长、术后恢复慢等诸多弊端,所以外科医生正在积极尝试将各类微创术式应用于ASDis的治疗。前路腰椎椎体间融合术(anterior lumbar interbody fusion,ALIF)对椎间隙高度及腰椎生理前凸恢复效果更优,但同时也存在较高的血管、泌尿系统及腹腔脏器损伤风险。微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminallumbar interbody fusion,MIS-TLIF)在肌肉(如多裂肌)及韧带保护方面效果显著,但较开放术式,MIS-TLIF对冠状面和(或)矢状面畸形的矫正效果有限,且存在较高的上关节突关节破坏发生率。外侧腰椎椎体间融合术(lateral lumbar interbody fusion,LLIF)的冠状面和(或)矢状面畸形矫正效果显著,椎间隙处理彻底、椎间融合率高,椎间隙高度恢复佳,但因髂嵴的遮挡使其应用受限,且有损伤腰丛及髂血管的风险。极外侧腰椎椎体间融合术(extreme lateral lumbar interbody fusion,XLIF)的髂血管损伤风险低,对原内植物影响小,椎间融合效果好,但不适用于曾有腹膜后手术史、罹患腹膜后脓肿或存在血管变异的患者,术中常需神经电生理监测。斜外侧腰椎椎体间融合术(oblique lumbar interbody fusion,OLIF)较开放术式存在手术创伤小、常见并发症(如硬脊膜损伤)风险低等优点,但因其术中需牵拉交感神经,�
Adjacent segment degeneration(ASDeg)is a common complication occurring in patients after lumbar fusion,mainly manifested as adjacent disc herniation,adjacent vertebral fracture or spondylolisthesis,adjacent segment scoliosis,adjacent segment spinal canal stenosis or facet joint degeneration,etc.When patients with imaging manifestations of ASDeg present with clinical symptoms such as lumbosacral pain,root lower limb pain or intermittent claudication,it is called adjacent segment disease(ASDis),and reoperation is often required at this time.At present,open surgery has been widely used in the treatment of symptomatic ASDis,including fusion via posterior approach and transforaminal approach,etc.The traditional surgery is effective,but it always has many disadvantages,such as large surgical trauma,large intraoperative blood loss,long operation time and hospital stay,and slow postoperative recovery.Therefore,surgeons are actively trying to apply various minimally invasive procedures to the treatment for symptomatic ASDis.Anterior lumbar interbody fusion(ALIF)has better recovery effect on intervertebral space height and lumbar lordosis,but it also has higher risk of vascular,urinary system and abdominal organ injury.Minimally invasive transforaminallumbar interbody fusion(MIS-TLIF)has a significant effect on the protection of muscles(such as multifidus muscle)and ligaments.However,compared with open surgery,MIS-TLIF has a limited effect on the correction of coronal and sagittal malformations,and has a higher incidence of superior facet joint violation.lateral lumbar interbody fusion(LLIF)has significant correction effect on coronal and sagittal malformations,complete treatment of intervertebral space,high intervertebral fusion rate,and good intervertebral space height recovery.However,due to the influence of the iliac crest,the surgical segment of LLIF is limited,and there is a risk of injury to the lumbar plexus and iliac vessels at the lower lumbar spine.Extreme lateral lumbar interbody fusion(XLIF)has a low risk of i
作者
傅栋铭
周鸿猷
李然
杨惠林
孟斌
Fu Dongming;Zhou Hongyou;Li Ran;Yang Huilin;Meng Bin(Department of Orthopaedics,the First Affiliated Hospital of Suzhou University,Suzhou 215000,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第19期1321-1328,共8页
Chinese Journal of Orthopaedics
基金
江苏省科委社会发展基金(BE2022730)。
