从生物力学角度看腰椎手术发展

Development of Lumbar Surgery from Biomechanical Perspectives

外科手术作为腰椎退行性疾病(lumbar degenerative diseases,LDDs)的重要治疗手段,其进展依赖于人们对脊柱生物力学理念的理解与革新。充分认识腰椎衰老退变过程中生物力学改变是理解LDDs发病过程、改革LDDs手术策略,进而采用针对性更强、更微创治疗方法的重要基础。本文阐述LDDs与椎体、椎间盘及椎旁肌退变生物力学之间关系,并按照腰椎手术特点,将腰椎手术发展史大致划分为无内植物时代(1980年前)、内植物时代(1980~1990年)、脊柱融合时代(1990~2010年)及精准微创减压时代(2010年往后),分别凝练各时代重要生物力学研究对腰椎手术发展的意义。从生物力学角度而言,脊柱手术发展史就是随着人们对脊柱生物力学认识不断深入而变革手术策略的发展史。紧跟生物力学研究不断深入,一步一脚印开发更适应脊柱生理生物力学特征的治疗策略,从而指导未来脊柱手术发展方向。

Lumbar surgical operation is the crucial treatment against lumbar degenerative diseases(LDDs),whose development depends on persistent comprehension and innovation of vertebral biomechanics.The thorough understanding of biomechanical changes during lumbar senescence and degeneration is the important bedrock to grasp LDDs pathogenesis,renovate LDDs surgical strategy,and embrace more precise and minimally invasive treatment against LDDs.Herein,in this review,the intimate crosstalk between LDDs with degenerative biomechanics of vertebrae,intervertebral disc and paravertebral muscles was elucidated,followed by the classification of lumbar surgery history into non-vertebral implant era(before the year 1980),vertebral implant era(during the year 1980-1990),vertebral fusion era(during the year 1990-2010),precise and minimally invasive decompression era(after the year 2010)based on lumbar surgical characteristics in each era.The significance of representative biomechanical studies in each era for lumbar surgery was also concluded.From biomechanical perspectives,the history of spinal surgery is the development history of surgical strategies that has progressed as the continuously in-depth understanding of spinal biomechanics.With the deepening of spinal biomechanical researches,spinal surgeons are expected to develop treatment strategies that are more adapted to physiological and biomechanical characteristics of the spine,thereby guiding the future direction of spinal surgery advancement.