侧方入路腰椎融合治疗后的生物力学稳定性的研究与进展

Research progress in biomechanical stability of lateral lumbar interbody fusion

背景:侧方入路腰椎融合临床应用越来越广泛,关于侧方入路腰椎融合的生物力学研究日益增多。目的:总结近年来侧方入路腰椎融合的生物力学研究进展,以期对临床医师应用侧方入路腰椎融合治疗腰椎疾病有一定的指导作用。方法:在中国知网、万方数据库、PubMed数据库,分别以“侧方入路腰椎融合术”“极外侧入路腰椎融合术”“侧前方入路腰椎融合术”“有限元”“生物力学”“lateral lumbar interbody fusion”“direct lateral interbody fusion”“extreme lateral interbody fusion”“oblique lumbar interbody fusion”“Finite element”“Biomechanics”为关键词,最终检索到32篇文献进行综述。结果与结论:①目前对侧方入路腰椎融合的生物力学研究主要包括与前后路手术的对比、侧方入路腰椎融合不同内固定方式的稳定性、侧方入路腰椎融合术后邻椎病发病率、侧方入路腰椎融合新型内固定物的研究;②侧方入路腰椎融合生物力学稳定性与前方入路腰椎融合、后方入路椎间融合相似,优于经椎间孔入路腰椎融合,临床医师在选择手术方式时,可优先考虑侧方入路腰椎融合;③侧方入路腰椎融合并双侧椎弓根钉棒固定和侧板棘突板联合固定具有最好的生物力学性能,建议临床医师将此2种内固定方式作为首选;④虽然关于侧方入路腰椎融合的生物力学研究较多,但极外侧和侧前方椎间融合之间的生物力学基础研究较少,因极外侧椎间融合是经腰大肌入路,侧前方椎间融合是经腰大肌前方入路,破坏和保留腰大肌是否对侧方入路腰椎融合后的生物力学稳定性有影响,还有待进一步研究。

BACKGROUND:Lateral lumbar interbody fusion has become more and more widely used in clinic.Biomechanical research on lateral lumbar interbody fusion is increasing.OBJECTIVE:To summarize the biomechanical research progress of lateral lumbar interbody fusion and expect to provide some guidance for clinicians to use lateral lumbar interbody fusion in the treatment of lumbar spine diseases.METHODS:CNKI,Wanfang,and PubMed databases were retrieved.The Chinese key words were“lateral lumbar interbody fusion,extreme lateral interbody fusion,direct lateral interbody fusion,finite element,biomechanics”.The English key words were“lateral lumbar interbody fusion,direct lateral interbody fusion,extreme lateral interbody fusion,oblique lumbar interbody fusion,finite element,biomechanics”.Finally,32 articles were included for review.RESULTS AND CONCLUSION:(1)Current biomechanical research on lateral lumbar interbody fusion mainly includes comparison between lateral lumbar interbody fusion and anterior-posterior surgery,stability of different internal fixation methods of lateral lumbar interbody fusion,incidence of adjacent vertebral disease after lateral lumbar interbody fusion,and research on new internal fixations of lateral lumbar interbody fusion.(2)The biomechanical stability of lateral lumbar interbody fusion is similar to that of anterior lumbar interbody fusion and posterior lumbar interbody fusion,and is better than that of transforaminal lumbar interbody fusion.Clinicians can give priority to lateral lumbar interbody fusion when choosing the operation methods.(3)Bilateral pedicle screw rods and lateral plate and spinous plate joint fixation has the best biomechanical performance.It is recommended that clinicians use this two internal fixation methods as the first choice.(4)Although there are many biomechanical studies on lateral lumbar interbody fusion,there are few basic biomechanical studies between extreme lateral interbody fusion and oblique lateral interbody fusion,because extreme lateral interbody fusion is through the transpsoas muscle approach,and oblique lateral interbody fusion is through the anterior approach of the psoas major muscle.Whether the psoas major has an effect on the biomechanical stability after lateral lumbar interbody fusion deserves to be further studied.