各种腰椎融合技术在腰椎退行性疾病中的应用与探讨

发布时间：2019-01-28 21:05

【摘要】：腰椎退行性疾病是脊柱外科的一种常见病多发病,是老年人残疾的最常见的原因之一。腰椎退行性疾病可导致腰背疼痛和神经根性症状,严重者可出现跛行和移动能力降低,患者生活质量低下。进行腰椎融合术可稳定疼痛节段、神经减压、恢复脊柱滑脱和矫正畸形等,是腰椎退行性疾病有效的治疗选择。腰椎融合的手术主要包括:后外侧融合(PLF)、前路腰椎椎体间融合(ALIF)、后路腰椎椎体间融合(PLIF)、经椎间孔腰椎椎体间融合(TLIF)、微创经椎间孔腰椎椎体间融合(MIS-TLIF)、侧路腰椎椎间融合术(LLIF)和斜外侧椎间融合术(OLIF)等等。其适应症包括:以各种腰椎退行性病变为主,包括椎间盘源性腰背痛、腰椎管狭窄、腰椎滑脱和脊柱畸形等。一般来说,PLF简便易行,但软组织剥离范围大,整体融合率也不高。PLIF有可接受的融合率,但是硬膜囊和神经根牵拉以及对脊旁肌肉组织的医源性损伤限制了PLIF的使用。TLIF来自于对PLIF的改良,降低了损伤脊柱后方结构的风险,但是入路对侧减压较难,临床效果不稳定。ALIF避免了对腰椎后方结构的损伤,但是易发生严重的腹部和血管并发症。为了改善传统腰椎手术融合相关的创伤和并发症等一系列问题,微创腰椎融合术迅速发展了起来。MIS-TLIF、LLIF和OLIF能减少开放手术相关的并发症。但是,LLIF和OLIF技术具有损伤腰丛和腰肌的潜在风险,其临床效果和融合率还需要长时间随访验证。本文旨在全面审查各种腰椎间融合技术的现有文献和证据,提供每种方法的适应症与禁忌症以及益处和缺点的描述,并提出一套针对不同腰椎退行性疾病患者腰椎融合手术的临床建议和选择指南。
[Abstract]:Lumbar degenerative disease is a common disease in spinal surgery and one of the most common causes of disability in the elderly. Lumbar degenerative diseases can lead to lumbar back pain and nerve root symptoms. In severe cases, lameness and mobility decrease, and the quality of life of patients is low. Lumbar fusion can stabilize the pain segment, decompress the nerve, restore the spondylolisthesis and correct the deformities. It is an effective choice for the treatment of lumbar degenerative diseases. Lumbar fusion surgery mainly includes: posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), lateral lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF), etc. The indications include lumbar degenerative diseases, including lumbar disc back pain, lumbar spinal stenosis, lumbar spondylolisthesis and spinal deformity. Generally speaking, PLF is simple and easy to perform, but the soft tissue stripping range is large and the overall fusion rate is not high. PLIF has an acceptable fusion rate. But dural sac and nerve root traction and iatrogenic damage to paraspinal muscle tissue limit the use of PLIF. TLIF comes from an improved PLIF that reduces the risk of injury to the posterior structure of the spine, but is more difficult to decompress contralateral through the approach. ALIF avoids injury to the posterior structure of the lumbar spine, but is prone to severe abdominal and vascular complications. In order to improve a series of problems such as trauma and complications associated with traditional lumbar fusion, minimally invasive lumbar fusion has developed rapidly. MIS-TLIF,LLIF and OLIF can reduce the complications associated with open surgery. However, LLIF and OLIF techniques have a potential risk of injury to the lumbar plexus and psoas muscle, and its clinical effect and fusion rate need to be verified for a long time. The aim of this paper is to provide a comprehensive review of the available literature and evidence on various lumbar fusion techniques and to provide a description of the indications and contraindications of each method, as well as of its benefits and shortcomings. A set of clinical recommendations and selection guidelines for lumbar fusion surgery for patients with different lumbar degenerative diseases were proposed.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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