斜外侧椎间融合技术的研究进展

Research progress of oblique lateral interbody fusion

斜外侧椎间融合术(OLIF)是目前脊柱外科新开展的一项微创椎间融合术。该术式从前侧方斜行经左下腹腹外斜肌、腹内斜肌、腹横肌的肌间隙进入腹膜外间隙,在左侧腰大肌前缘和腹部大血管鞘之间的生理间隙置入器械通道,通过置入更大的椎间融合器撑开椎间隙达到椎管和椎间孔的间接减压。OLIF适用于腰椎滑脱、腰椎管狭窄症、腰椎间盘突出合并节段不稳、退行性脊柱侧后凸畸形等情况。该术式具有创伤小、手术时间短、术中出血少、住院时间短、术后康复快、间接减压效果明显及临床疗效肯定等优点,并且能够有效避免后路椎间融合术引起的脊柱后方肌肉和韧带等软组织、骨性结构、脊髓和神经损伤。但OLIF作为一项新技术,术后出现供骨区疼痛、屈髋乏力、大腿疼痛麻木、终板骨折、融合器下沉、血管和神经损伤等并发症屡见报道。本文主要从OLIF手术的解剖结构、适应证、禁忌证、临床疗效及并发症等方面作一综述。

The oblique lateral interbody fusion(OLIF)is a new minimally invasive interbody fusion in spine surgery.The procedure is obliquely from the anterior lateral direction through the left lower abdominal extra-abdominal oblique muscle,the intra-abdominal oblique muscle,and the transverse abdominis muscle to enter the extraperitoneal space and place the instrument channel in the physiological gap between the left lumbar muscle front and the abdominal large blood vessel sheath.The OLIF procedure achieve indirect decompression of the spinal canal and intervertebral foramen through the placement of a larger cage to open the intervertebral space.It is applicable to lumbar spondylolisthesis,lumbar spinal stenosis,lumbar disc herniation combined with segmental instability and degenerative kyphosis.The procedure has the advantages of minor trauma,shorter operation time,less intraoperative blood loss,shorter hospitalization time,quicker postoperative rehabilitation,obvious indirect decompression effect and positive clinical efficacy.OLIF can effectively avoid the damage of muscles and ligaments,osseous structures,spinal cord and nerves which may be caused by posterior lumbar interbody fusion.However,as a new technology,OLIF has frequently reported complications such as pain in the donor position,weakness,numbness and pain of hip,endplate fracture,sinking of the cage,injury of the vascular and nerve.This article mainly reviews the anatomical structure,indications,contraindications,clinical efficacy and complications of OLIF surgery.