小切口在单节段腰椎间盘置换术的应用

A Small Anterior Incision Applied to Single Lumbar Segment Artificial Disc Replacement

目的 介绍一种在单节段人工腰椎间盘置换术时采用的微创手术入路。方法 回顾性调查 9例已行单节段人工椎间盘置换的患者的切口长度、手术持续时间、术中出血量、术中及术后并发症和手术效果 ,结合相关文献介绍一种经左侧腹直肌鞘腹膜外显露腰椎前方行单节段人工椎间盘置换的方法及该入路的优点。结果 平均切口长度 6 7cm ,平均手术时间 15 0min ,平均出血量 3 3 5ml ,Likert评分显示手术疗效满意 ( P =0 0 0 8) ,未出现与手术入路有关的严重并发症。结论 小切口经腹直肌鞘腹膜外入路暴露腰椎前方安全 ,创伤小 ,可显露腰 3以下包括腰 5骶 1在内的所有腰椎节段 。

Objectives To introduce a small incision of anterior extraperitoneal approach to the lumbar spine for single lumbar segment artificial disc replacement. Methods Nine patients suffered from single segment herniation of lumbar intervertebral disc underwent operation of artificial disc replacement. The approach of this operation was with a small incision through medial of left sheath of rectums and access to the retroperitoneal region through extraperitoneal appearance. The clinical and surgical data including the length of incision, length of operation, blood lose, effect and complication of operation were analyzed retrospectively in these 9 patients.Results The average length of incision,time of operation and blood lose was 6 7cm, 150 minutes and 335ml, respectively. The clinical evaluation scales (the 5-point Likert scales for pain, function, economic status, and medication usage) showed great improvement after operation of these patients(P=0 008). No serious complication related with the approach was found. Conclusions The a small anterior incision through peritoneum of left rectus abdominis sheath and access to the retroperitoneal region through extraperitoneal, which can expose the region of lumbar segment from L3 to S1 sufficiently, is a safe and mini-lesion approach for single lumbar segment artificial disc replacement.