改良腹直肌旁入路在下腰椎前路手术中的应用

Modified Lateral Rectus Approach Applied for Anterior Lower Lumbar Operation

目的 探讨改良腹直肌旁腹膜外入路在腰椎前路手术中的应用价值。方法 2 0 0 0年 12月～ 2 0 0 3年 12月应用改良腹直肌旁腹膜外入路行椎体间植骨结合后路椎弓根螺钉内固定系统治疗腰椎滑脱症 36例 ,结核病灶清除植骨融合术 12例 ,腰椎爆裂性骨折椎体次全切除植骨内固定 2例 ,腰椎体肿瘤切除术 4例 ,腰椎间隙感染病灶清除术 2例。结果 病椎显露平均时间为15 8min,显露过程平均出血量 4 5 6ml,术后切口愈合良好 ,切口旁皮肤感觉正常。结论 改良腹直肌旁腹膜外入路为下腰椎前路手术提供简单便捷的手术入路 ,尤其适合于椎体间融合术及病灶清除术。

Objective To study the value of anterior modified lateral rectus and extraperitoneal approach applied for anterior lower lumbar operation.Methods From Dec 2000 to Dec 2003,36 patients with lumbar spondylolysthesis were treated with pedicle screw fixation system by posterior approach combined with interbody fusion by anterior modified lateral rectus and extraperitoneal approach.Twelve patients with lumbar tuberculosis were treated with focal resection and fusion.Two patients with lumbar burst fracture were treated with decompression and internal fixation and fusion.Four patients with lumbar tumor were resected and 2 patients with lumbar disc infection were treated with focal scavenger.Results Average time of the lesion exposure was 15.8 minutes.Average amount of bleeding was 45.6 ml during the lesion exposure.The incision healed well and the skin sensation around incision was normal.Conclusion The anterior modified lateral rectus and extraperitoneal approach was simple and less traumatic for anterior lower lumbar operation.It was more suitable for interbogy fusion and focal scavenger.