腰椎前路椎体间融合固定治疗腰椎滑脱症的治疗分析

Treatment of Lumbar Spondylolisthesis with Anterior Lumbar Vertebral Fusion

目的介绍一种前路腰椎融合方法,探讨其手术适应证、手术注意事项及力学特性。方法 2011年1月至2014年1月共采用前路椎体间植骨融合术（anterior lumbar interbody fusion,ALIF）腰椎融合固定（KLA-PACH固定）治疗腰椎滑脱症12例,男7例,女5例;年龄45~64岁,平均50.4岁;Ⅰ度7例,Ⅱ度5例;滑脱位于L4~5节段9例,L5S1节段3例,采用疼痛视觉模拟评分（visual analogue scale,VAS）、下腰痛日本骨科协会评分（Japanese orthopaedic association,JOA）评价患者术前及术后症状改善情况,定期复查腰椎X线片观察脊柱融合情况。结果本组均顺利完成手术,手术时间平均95 min,失血量平均300 m L,1例术中髂血管破裂经修补后完成手术。所有病例均获得6~32个月,平均16个月随访。VAS评分由术前平均6.8分降至末次随访时平均0.8分,差异有统计学意义（P〈0.05）;JOA评分由术前平均9.8分升至末次随访时平均21.8分,差异有统计学意义（P〈0.05）;参照Suk和Mc Afee的融合标准,12例植骨全部融合,融合率100%,平均植骨融合时间9个月。结论利用前路ALIF术式治疗腰椎滑脱症,融合效果确定,脊柱后柱结构保留完整,神经无干扰,有效的恢复椎体间高度,维持腰椎生理曲度,术后疗效满意。但其手术路径并非为大多数骨科医师所熟悉,且髂血管的遮挡和潜在的损伤风险使得这一术式未被广泛接受。

Objective To introduce an anterior lumbar interbody fusion surgery,including indication、cautions and mechanical characteristics of this operation. Methods From January 2011 to January 2014,12 cases of lumbar spondylolisthesis underwent anterior lumbar fusion fixation（ KLA-PACH fixed）. There were 7 male cases,5 female cases with an average age of50. 4 years old（ range 45 to 64）. There were Ⅰ°in 7 cases,Ⅱ°in 5 cases,9 cases of spondylolisthesis in L4 ~ 5segment,3 cases in L5S1 segment. VAS score and JOA score of low back pain were used to evaluate preoperative and postoperative symptom.The lumbar spinal fusion was observed by X-ray. Results All operations were successful,the average operation time was 95 min,blood loss was 300 m L. 1 case of iliac vein rupture was repaired. All cases were followed for 6 ~ 32 months,average 16 months. VAS score decreased from 6. 8 preoperatively to 0. 8 at the final follow-up. JOA score increased from 9. 8 preoperatively to 21. 8 at final follow-up. The difference was statistically significant（ P〈0. 05）. According to Suk and Mc Afee fusion criterion,fusion rate was 100%,the average fusion time was 9 months. Conclusion Effect of ALIF for lumbar spondylolisthesis are satisfying. This operation integrates spinal posterior column without nerve interference,effective restore of vertebral body height,maintain physiological curvature of the spine. However the most orthopedics physicians are not familiar with this procedure. Occlusion and the potential risk of injury of iliac blood vessel make this technique no widely be accepted.