侧前路腰椎椎间融合联合后方肌间隙入路内固定分期手术治疗退变性脊柱侧凸
Staged mini-open lateral-anterior lumbar interbody fusion combined with posterior instrumentation via Wilste ap-proach:an alternative minimally invasive treatment strategy for adult degenerative scoliosis
郑召民 1张华峰 2王建儒3
作者信息
- 1. 中山大学附属第一医院脊柱外科,广州 510080;郑州大学脊柱畸形研究所,郑州 450052
- 2. 郑州大学脊柱畸形研究所,郑州 450052;郑州大学第一附属医院骨科,郑州 450052
- 3. 中山大学附属第一医院脊柱外科,广州 510080
- 折叠
摘要
退变性脊柱侧凸患者随人口老龄化持续增加,其治疗一直是脊柱外科的难题之一.退变性脊柱侧凸患者常合并多种内科疾病和骨质疏松、肌少症等骨骼肌肉问题,开放手术的并发症多、手术风险高,微创手术治疗越来越为患者和医生接受.侧方入路腰椎椎间融合术具有创伤小、出血少、术后恢复快、神经损伤风险低、融合器植骨面积大等优势.侧前路腰椎椎间融合术是一种新型的微创小切口侧方腰椎椎间融合术式,切口介于极外侧腰椎椎间融合术和斜外侧椎间融合术之间,全程直视下操作,无需劈开腰大肌,肌肉神经损伤风险小,垂直植入融合器,学习曲线平缓.后方肌间隙入路内固定术具有操作简便、手术时间短、射线暴露少、肌肉损伤小、可植骨融合和去旋转操作的优点,更适合于退变性脊柱侧凸的后路微创内固定.分期手术策略明显减少了单次手术和麻醉的时间,降低了手术风险,利于术后恢复.侧前路腰椎椎间融合术联合后方肌间隙入路内固术的分期手术策略,可以充分发挥两种微创手术的优势,将每次手术的创伤降至最低,明显减少手术并发症,提高临床疗效,为退变性脊柱侧凸的微创治疗提供了一种有效的手术选择.
Abstract
With the aging of the population,the number of patients with degenerative scoliosis continues to increase.Sur-gical treatment of degenerative scoliosis is challenging.Patients with degenerative scoliosis often present with multiple comorbidi-ties,osteoporosis,and sarcopenia.Traditional open surgeries are associated with high risks and multiple complications,whereas minimally invasive surgeries have increasingly gained acceptance among patients and physicians.Lateral Lumbar Interbody Fu-sion(LLIF)offers advantages such as minimal trauma,less blood loss,rapid postoperative recovery,reduced risk of neural compli-cations,and larger interbody cages with more grafting capacity.Mini-open lateral-anterior lumbar interbody fusion is a new stan-dardized LLIF technique with smaller incisions,which does not require splitting the psoas muscle,thereby reducing the risk of muscle and nerve injuries,and involves vertical implantation of the fusion device.Posterior instrumentation via the Wiltse ap-proach is characterized by shorter operational times,minimal radiation exposure,reduced muscular damage,increased graft fusion capabilities,and the ability to perform de-rotation maneuvers.Therefore,the Wiltse approach is particularly suitable for patients with degenerative scoliosis.Staged surgery significantly reduces the duration of each surgery and anesthesia,lowering surgical risks and enhancing postoperative recovery.Staged mini-open lateral-anterior lumbar interbody fusion and posterior instrumenta-tion via the Wiltse approach maximizes the reduction of surgical trauma,significantly decreases surgical complications,and offers marked clinical outcomes,providing an alternative minimally invasive treatment for degenerative scoliosis.
关键词
腰椎/椎间盘退行性变/脊柱侧凸/最小侵入性外科手术Key words
Lumbar vertebrae/Intervertebral disc degeneration/Scoliosis/Minimally invasive surgical procedures引用本文复制引用
基金项目
2023年广州市卫生健康委员会特色技术项目基金(C3230110)
出版年
2024
NETL
NSTL
万方数据