斜外侧入路腰椎融合内固定的生物力学稳定性

Biomechanical stability of oblique lateral lumbar fusion and internal fixation

背景:斜外侧入路腰椎融合在临床上的应用越来越多,对斜外侧入路腰椎融合内固定的生物力学研究也越来越多。目的:总结近年来斜外侧入路腰椎融合内固定的生物力学研究进展,为临床上应用斜外侧入路腰椎融合治疗腰椎退行性疾病提供参考。方法:在知网、万方数据库、PubMed数据库、Web of science数据库等分别以“斜外侧腰椎融合术,侧前方腰椎融合术,有限元分析,生物力学,腰椎融合术”及“Oblique lateral interbody fusion,Oblique lumbar interbody fusion,Finite element analysis,Biomechanics,Lumbar interbody fusion”为中英文关键词,根据条件进行筛选,最终纳入45篇文献进行综述。结果与结论:①现在对斜外侧入路腰椎融合的生物力学研究较少,主要包括与其他入路腰椎融合术的对比、不同内固定方式的稳定性比较、术后邻近节段退变、不同类型融合器等研究;②斜外侧入路腰椎融合生物力学稳定性与侧方入路腰椎融合无显著区别,优于其他入路腰椎融合;③斜外侧入路腰椎融合联合双侧椎弓根钉棒固定具有最好的生物力学稳定性,建议临床医生把该术式作为斜外侧入路腰椎融合的首选术式;④斜外侧入路腰椎融合与前入路腰椎手术的生物力学比较研究还很不足,临床结果比较也较少,需进一步深入研究。

BACKGROUND:The oblique lateral approach interbody fusion is used more and more clinically.There are more and more biomechanical studies on the oblique lateral approach interbody fusion and internal fixation.OBJECTIVE:To summarize the research progress of the biomechanics of the oblique lateral approach interbody fusion and internal fixation in recent years so as to provide important reference value for the clinical application of the oblique lateral approach interbody fusion for the treatment of lumbar degenerative diseases.METHODS:In CNKI,Wanfang,PubMed,and Web of Science databases,“oblique lateral interbody fusion,oblique and anterior lumbar interbody fusion,finite element analysis,biomechanics,lumbar interbody fusion”were selected as the key words,and 45 articles were finally included for review.RESULTS AND CONCLUSION:(1)There are few studies on the biomechanics of oblique lateral approach interbody fusion,mainly including the comparison of lumbar interbody fusion with other approaches,stability comparison of different internal fixation methods,postoperative adjacent segmental degeneration,different types of fusion apparatus and so on.(2)The biomechanical stability of the oblique lateral approach is not significantly different from that of the lateral approach,which is better than other approaches.(3)Oblique lateral approach interbody fusion combined with bilateral pedicle screw fixation has the best biomechanical stability,and it is recommended that clinicians apply this technique as the first choice for oblique lateral approach interbody fusion.(4)Comparative studies of biomechanics between oblique lateral approach interbody fusion and anterior approach interbody fusion are insufficient,and there are few clinical outcomes comparisons,and further research is needed.