AxiaLIF在腰骶椎融合治疗中的应用

Axia Lif application in lumbosacral vertebral fusion

背景:腰骶椎融合手术是治疗腰骶椎退行性疾病的重要方法,而传统的开放融合手术创伤较大、术后康复时间较长、并发症较多,为了减少对正常组织的损伤和提高愈合率,国内外学者对腰椎融合手术进行改良,腰椎融合微创手术的发展成为一种趋势。2004年Cragg提出经骶骨前入路经皮腰骶椎轴向融合术(Axia LIF),该术式是经直肠后壁和骶前间隙入路,轴向置钉,对L5/S1进行融合,保留了脊柱重要的肌肉、韧带血管等结构的完整,与传统的融合手术有相似的力学稳定性,手术节段的骨性融合率高等优点,符合脊柱微创手术的理念。目的:综述国内外文献,从传统腰椎融合和目前腰椎融合角度总结其优势与不足,并探讨Axia LIF在腰骶椎融合手术治疗中的应用进展。方法:以"Axial interbody fusion and(properties or evaluation),biomechanics,spine mechanical test,spine and(kinematics or motion)"为英文检索词检索Pub Med,Web of Science,Springer数据库,以"轴向融合,生物力学研究评估,生物力学,骶骨前间隙,脊柱微创"为检索词检索中文期刊全文数据库,纳入腰椎融合术及并发症、生物力学、人文医学等相关文献,主要整理近5年来该领域内的经典文献,排除重复性工作,重点对46篇文献进行分析讨论。结果与结论:近90年来国内外学者从各个层面对腰椎融合手术的方式展开了研究,分析和总结各种术式的优缺点,明确了腰椎疾病融合手术的指征。文章通过综述性对比开放手术和微创手术的特点,表明目前腰椎融合微创手术已成为一种发展趋势,对Axia LIF术后生物力学稳定性、并发症、术后康复时间等方面的深入了解,在未来的医学研究道路上,仍旧任重而道远。

BACKGROUND:Lumbosacral vertebral fusion operation is an important treatment for lumbosacral vertebral degenerative disease.Traditional open surgery has great trauma;postoperative recovery time is longer;there are more complications.To reduce the damage to normal tissue and increase the rate of healing,scholars in and outside China improve the lumbar spine fusion surgery,and lumbar fusion becomes a tendency of the development of minimally invasive surgery.In 2004,Cragg introduced lumbosacral vertebral axial fusion(AxiaLIF,axial lumbar intervertebral fusion).The operation is through posterior rectal wall and presacral space approach,axially nailing for fusion of L5/S1.Muscle,ligament and blood vessels of the spine were retained.Mechanical stability was similar to that of traditional fusion.Osseous fusion rate was high at the operation segment.This is in line with the concept of minimally invasive surgery of the spine.OBJECTIVE:To summarize the advantages and disadvantages of traditional and present fusion techniques from traditional lumbar fusion and present lumbar fusion angle,and to explore the application of AxiaLIF in lumbosacral fusion.METHODS:We retrieved PubMed,Web of Science,and Springer database with the English key words of“Axial interbody fusion and(properties or evaluation),biomechanics,spine mechanical test,spine and(kinematics or motion)”,and Chinese Journal Full-Text Database with the Chinese key words of“Axial fusion,biomechanics research assessment,biomechanics,anterior sacral space,minimally invasive spine”for studies concerning lumbar fusion,complications,biomechanics,and humanistic medicine that had been published in recent 5 years.Repetitive studies were excluded,and 46 studies were analyzed and discussed.RESULTS AND CONCLUSION:In the past 90 years,scholars in and outside China had studied the methods of lumbar fusion from various levels,analyzed and summarized the advantages and disadvantages of various operative methods,and identified the indications of lumbar spinal fusion.By comparing characteristics of open surgery and minimally invasive surgery,this study suggested that minimally invasive lumbar fusion has become a trend.In-depth understanding of biomechanical stability,complications,and postoperative recovery time after AxiaLIF is still a long way to go in future medical research.