世界首例腹腔镜下腰椎人工椎间盘置换术

The First Case of Lumbar Artificial Disk Replacement by Laparoscope in the World

目的世界首例腹腔镜下腰椎人工椎间盘置换术的经验及初步临床疗效。方法53岁男性患者,确诊为L4/5椎间盘突出症,行腹腔镜下腰椎人工椎间盘置换术,所用假体为Active-L(Aesculap,Tuttlingen,Germany)。手术包括先行腹腔镜下L4/5间隙的显露,切除L4/5椎间盘,再植入人工椎间盘假体。手术操作均在腹腔镜下完成。结果手术成功完成,手术时间120 min,其中显露L4/5椎间隙约30 min,间盘切除及椎间隙处理约40 min,假体植入约50 min。术中失血约120 mL,术中C臂透视见假体位置良好,术后3天拔除腹腔引流管。并于术后3天、4周、6周复查腰椎X线片,结果显示假体无松动、移位及下沉。现随访6周,患者自我感觉满意,腰痛明显缓解。结论随着脊柱外科技术的发展,特别是微创和非融合技术的进步,腹腔镜下腰椎人工椎间盘置换术有望成为腰椎疾病治疗的另一新方向。

Objective The experience and primary clinic therapeutic effect of the first case of lumbar artificial disk replacement by laparoseope in the world. Methods A 53 - year - old man who was diagnosed as protrusion of L4/5 irt- ervertebral disc. The operation of the lumbar artificial disk replacement by laparoseope was performed safely and the prosthesis was the type of Active - L （ Aesculap, Tuttlingen, Germany ）. The operation included there steps： exposed L4/5 interspace firstly and removal the degenerative disk, then implanted the artificial disk. All surgical procedures were finished by laparoseope. Results The operation was completed successfully. The operation time was 120 min, the time of exposure L4/5 interspace and mobilization of the vascular was 30 min,40 min in disk removal and intervertebral space disposal. It cost 60 rain to implant the artificial disk. In operation,the blood loss was 120 mL and the postion of artificial disk was fine by C - arm during the operation. To puU out the abdominal cavity drainage tube in 3 days postoperative. Rechecked the lumbar aetinogram in 3 days ,4 weeks ,8 weeks postoperative and the outcome showed that there were no mobilize, displacement or subsidence. The patient ＇ s self - sensation was satisfied and the low back pain was relieved obviously in 2 months follow - up. Condusion The minimally invasive and non - fusion technics are improving in spinal surgery. The lumbar artificial disk replacement by laparoseope can be a feasible minimally invasive technique in treating lumbar degenerative diseases.