L5S1椎间盘突出伴狭窄斜外侧腰椎间融合联合内镜减压△

Oblique lateral interbody fusion combined with endoscopic decompression for L5S1 disc herniation complicated with stenosis

摘要:

[目的] 介绍L5S1 椎间盘突出伴狭窄斜外侧腰椎间融合（oblique lateral interbody fusion, OLIF） 联合内镜减压的手术技术和初步临床结果。[方法] 患者全麻后侧卧于手术床上，透视椎间隙在左侧的体表投影并标记。在单一体位下进行计算机辅助导航扫描、注册。沿体表投影行皮肤切口，并钝性分离三层腹肌，直抵腹膜后间隙。导航明确椎间隙无误，沿导针安装通道、叶片牵开并保护髂血管，在通道下进行椎间隙处理。椎间处理完成以后，通过OLIF 通道完成内镜下椎管腹侧的直接减压。撤除椎间孔镜设备，椎间植入合适的椎间融合器，安放钉板系统，逐层缝合皮肤。[结果] 所有患者均顺利完成手术，手术时间平均（300.2±63.7） min，术中失血量平均（240.4±33.2） ml，下地时间平均（54.4±12.2） h，住院时间平均（14.0±33.2）d。术后1 周下肢VAS 评分、后背痛VAS 评分、ODI、责任椎体间高度、椎间孔高度、椎孔的矢状径均明显改善。[结论] 内镜减压联合斜外侧腰椎间融合治疗L₅S₁ 椎间盘突出症合并椎管狭窄症，将内镜的直接减压优势和OLIF 的微创融合优势相结合，初步临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and initial clinical results of oblique lateral interbody fusion combined withendoscopic decompression for L₅S₁ herniation complicated with stenosis. [Methods] After general anesthesia, the patient was placed in a lat-eral position on the operating table, and the projection of the intervertebral space on the left side of the body surface was fluoroscopicallyidentified and marked. Computer-assisted navigation scanning and registration were performed in a single position. A skin incision wasmade along the projection of the body surface, and the three layers of abdominal muscles were bluntly separated until the retroperitonealspace was reached. The intervertebral space was confirmed by navigation, and a channel and blade were installed along the guide pin to re-tract and protect the iliac vessels. Intervertebral space was treated through the channel, and then direct decompression of the ventral aspectof the canal was endoscopically performed through the OLIF channel. A suitable interbody cage was implanted in the intervertebral spaceand screw-plate system was placed, finally the incision was closed in layers. [Results] All patients had operation performed smoothly withan average surgical time of (300.2±63.7) min, intraoperative blood loss of (240.4±33.2) ml, ambulation time of (54.4±12.2) hours, and hospi-tal stay of (14±3.2) days. At the latest follow-up lasted for 24 months, the pain visual analogous scale (VAS), ODI score, intervertebralheight, foraminal height, and sagittal diameter of the spine canal were significantly improved compared to those preoperatively. [Conclu-sion] This oblique lateral interbody fusion combined with endoscopic decompression for L5/S1 herniation complicated with stenosis take ad-vantages of direct decompression and the minimally invasive fusion, and achieve satisfactory primary clinical consequence.