同体位斜向椎体间融合与单侧椎弓钉固定技术

Oblique lumbar interbody fusion combined with unilateral pedicle screw fixation in the same position

[目的]介绍同体位斜向椎体间融合与单侧椎弓钉固定的手术技术和初步临床效果。[方法]2018年7月一2019年6月应用同体位下经斜外侧腰椎椎间融合术联合单侧椎弓根螺钉固定治疗腰椎退行性疾病患者43例。患者侧取右侧卧位,左腹部外侧行4cm斜切口,分离腹肌至腹膜后间隙。暴露椎间隙,切除椎间盘,置入填有同种异体骨的融合笼架。患者继续保持右侧卧位,行6 cm后正中旁侧切口,经肌间隙显露相应关节突和横突,置人椎弓根螺钉,装配连接棒固定。[结果]所有患者均顺利完成手术,术中出血量平均(50.42±10.34)ml;手术时间平均(79.24±12.26)min;总置钉时间平均(18.07±3.63)min。无严重神经、血管损伤。共置入椎弓根螺钉86枚,置钉准确率96.51%。术后1年复查CT,融合率达到100%。术后出现左侧大腿前内侧麻木不适的患者有2例,但均在术后6个月内症状明显改善。[结论]同体位斜向椎体间融合与单侧椎弓钉固定治疗腰椎退行性疾病可精简手术过程,同时缩短手术时间,且具有较高的安全性及较好的临床疗效。

[Objective]To introduce the surgical technique and preliminary clinical results of oblique lumbar interbody fusion combined with unilateral pedicle screw fixation in the same position.[Methods]From July 2018 to June 2019,43 patients underwent oblique lumbar interbody fusion combined with unilateral pedicle screw fixation in the same position.After the patient was placed in the right lateral decubitus position,a 4 cm oblique incision was made on the left abdomen to approach to the retroperitoneal space by separating the abdominal muscles.As the target intervertebral space was exposed,the disc was resected,and then a fusion cage with bone allografts was inserted into the space firmly.The patient remained in the right decubitus position,a 6cm posterior para-midline incision was made,the corresponding articular and transverse processes were exposed through the muscular space.The pedicle screws were placed,and then connecting rods were installed for fixation.[Results]All patients had operation completed successfully with intraoperative blood loss of(50.42±10.34)ml,operation time of(79.2±12.2)min,and the total screw placement time of(18.07±3.63)min,while without no serious nerve or vascular injury during operation.In the 43 patients,a total of 86 pedicle screws were inserted with screw placement accuracy of 96.51%.CT reexamination one year after the operation showed that the fusion rate was of 100%.In term of adverse event,2 patients developed numbness and discomfort in the anteromedial side of the left thigh after surgery,which were significantly improved within 6 months after surgery.[Conclusion]Oblique lumbar interbody fusion combined with unilateral pedicle screw fixation in the same position for lumbar degenerative diseases do simplify the operation process,save the operation time,and have high safety and good clinical efficacy.