退变性腰椎滑脱症的手术治疗进展
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摘要
退变性腰椎滑脱是临床上较为常见的骨科疾病,是引起老年人腰腿痛的主要原因之一。退变性腰椎滑脱的治疗分为保守治疗和手术治疗,在手术治疗中,术式较多,可分为单纯减压、非融合固定与融合固定等,后者包括后外侧融合、后路腰椎间融合、经椎间孔腰椎间融合、前路腰椎间融合、前后路联合融合(360°融合)等,临床上多推荐经椎间孔腰椎间融合术,但随着腰椎微创手术的不断发展,微创理念加深,斜外侧腰椎融合术等开始运用于临床,使得退变性腰椎滑脱的手术方式更加多样。
Degenerative lumbar spondylolisthesis is a common orthopedic disease in clinical,and it is the main cause of lumbago and leg pain in the elderly. The treatment of degenerative lumbar spondylolisthesis can be divided into conservative treatment and surgical treatment. As for the surgical treatment,the indications are extensive and there are many surgical methods,which can be divided into simple decompression,non-fusion fixation and fusion fixation. The fusion fixation includes posterolateral fusion,posterior lumbar fusion,transforaminal lumbar fusion,anterior lumbar fusion,anterior and posterior fusion( 360° fusion). Transforaminal lumbar interbody fusion is often recommended in clinical. However,with the development of minimally invasive lumbar surgery,the deepening of minimally invasive concept,oblique lateral lumbar fusion has gradually began to be applied to clinical practice,which makes the operation methods of degenerative lumbar spondylolisthesis more diverse.
Degenerative lumbar spondylolisthesis is a common orthopedic disease in clinical,and it is the main cause of lumbago and leg pain in the elderly. The treatment of degenerative lumbar spondylolisthesis can be divided into conservative treatment and surgical treatment. As for the surgical treatment,the indications are extensive and there are many surgical methods,which can be divided into simple decompression,non-fusion fixation and fusion fixation. The fusion fixation includes posterolateral fusion,posterior lumbar fusion,transforaminal lumbar fusion,anterior lumbar fusion,anterior and posterior fusion( 360° fusion). Transforaminal lumbar interbody fusion is often recommended in clinical. However,with the development of minimally invasive lumbar surgery,the deepening of minimally invasive concept,oblique lateral lumbar fusion has gradually began to be applied to clinical practice,which makes the operation methods of degenerative lumbar spondylolisthesis more diverse.
引文
[1]路闯,袁宏伟,代振动,等.退变性腰椎滑脱的手术治疗[J].中国实用医刊,2014,41(8):77-80.
[2]Herkowitz HN,Kurz LT,Overholt DP.Surgical management of cervical soft disc herniation.A comparison between the anterior and posterior approach[J].Spine(Phila Pa 1976),1990,15(10):1026-1030.
[3]Lurie JD,Tosteson TD,Tosteson A,et al.Long-term outcomes of lumbar spinal stenosis:Eight-year results of the spine patient outcomes research trial(SPORT)[J].Spine(Phila Pa 1976),2015,40(2):63-76.
[4]艾比不拉·吐尔逊,苏比·亚力买买提.腰椎管狭窄及退变性腰椎滑脱手术治疗的研究进展[J].新疆医学,2016,46(7):873-876.
[5]丁浩,周孜辉,沈强,等.单纯减压与减压融合内固定术治疗Ⅰ度退行性滑脱腰椎椎管狭窄疗效对比分析[J].河北医学,2016,22(4):560-563.
[6]Mardjetko SM,Connolly PJ,Shott S.Degenerative lumbar spondylolisthesis.A meta-analysis of literature 1970-1993[J].Spine(Phila Pa 1976),1994,19(20 Suppl):2256-2265S.
[7]陈毅,崔新刚,吴恙,等.改良小切口肌间隙入路双侧固定单侧减压TILF手术临床疗效分析[J].中国临床解剖学杂志,2017,35(5):554-558.
[8]王建钧,李剑锋.单纯椎板减压与联合腰椎融合术治疗腰椎Ⅰ度滑脱并椎管狭窄效果的Meta分析[J].中国综合临床,2018,34(6):553-557.
[9]Eismont FJ,Norton RP,Hirsch BP.Surgical management of lumbar degenerative spondylolisthesis[J].J Am Acad Orthop Surg,2014,22(4):203-213.
[10]Herkowitz HN,Kurz LT.Degenerative lumbar spondylolisthesis with spinal stenosis.A prospective study comparing decompression with decompression and intertransverse process arthrodesis[J].J Bone Joint Surg Am,1991,73(6):802-808.
[11]Martin CR,Gruszczynski AT,Braunsfurth HA,et al.The surgical management of degenerative lumbar spondylolisthesis:A systematic review[J].Spine(Phila Pa 1976),2007,32(16):1791-1798.
[12]在治疗腰椎管狭窄的方法中,手术减压加器械或非器械腰椎融合是否较单纯减压手术效果更佳?[C]//中华医学会骨科学分会.2007全国腰椎退行性疾患学术论坛论文集.青岛:中华医学会骨科学分会,2007:63-66.
[13]Schnake KJ,Schaeren S,Jeanneret B.Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis[J].Spine(Phila Pa 1976),2006,31(4):442-449.
[14]徐德太,谢洪波,彭明.腰椎非融合内固定术治疗老年稳定性腰椎退变性疾病近期疗效分析[J].当代医学,2018,24(2):106-108.
[15]曲扬,赵建武,董荣鹏,等.中老年稳定性腰椎退变性疾病的治疗策略--腰椎非融合内固定术[J].中国老年学杂志,2014,34(16):4520-4521.
[16]Sengupta DK,Herkowitz HN.Degenerative spondylolisthesis:Review of current trends and controversies[J].Spine(Phila Pa1976),2005,30(6 Suppl):S71-81.
[17]Hy K,Bünger C,Niederman B,et al.Transforaminal lumbar interbody fusion(TLIF)versus posterolateral instrumented fusion(PLF)in degenerative lumbar disorders:A randomized clinical trial with 2-year follow-up[J].Eur Spine J,2013,22(9):2022-2029.
[18]廖国平,邓芳文,孙德贵,等.后外侧腰椎融合术与后路椎间融合术比较治疗腰椎滑脱症疗效的Meta分析[J].临床医药实践,2016,25(4):259-267.
[19]Okuyama K,Kido T,Unoki E,et al.PLIF with a titanium cage and excised facet joint bone for degenerative spondylolisthesis-in augmentation with a pedicle screw[J].J Spinal Disord Tech,2007,20(1):53-59.
[20]王力,邱南海.腰椎滑脱的手术治疗进展[J].赣南医学院学报,2017,37(3):482-487.
[21]张烽,陈兵乾,居建文,等.TLIF、PLIF、ALIF三种椎间融合术后腰椎即刻稳定性的比较[J].江苏医药,2008,34(2):147-149.
[22]Ishihara H,Osada R,Kanamori M,et al.Minimum 10-year followup study of anterior lumbar interbody fusion for isthmic spondylolisthesis[J].J Spinal Disord,2001,14(2):91-99.
[23]刘新宇,原所茂,田永昊,等.两种经椎间孔椎体间融合治疗单节段腰椎退行性疾病的疗效比较[J].中华创伤杂志,2015,31(6):507-511.
[24]Humphreys SC,Hodges SD,Patwardhan AG,et al.Comparison of posterior and transforaminal approaches to lumbar interbody fusion[J].Spine(Phila Pa 1976),2001,26(5):567-571.
[25]顾祖超,张宇,李果,等.经椎间孔与经后外侧入路椎间融合术治疗退变性腰椎滑脱症的疗效比较[J].脊柱外科杂志,2017,15(4):200-205.
[26]Silvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion:Oblique lumbar interbody fusion in 179 patients[J].Asian Spine J,2012,6(2):89-97.
[27]沈俊宏,王建,刘超,等.斜外侧腰椎间融合术治疗退变性腰椎疾病的并发症和早期临床结果[J].中国脊柱脊髓杂志,2018,28(5):397-404.
[28]徐彬,徐峰,李涛,等.腰椎滑脱症的微创手术治疗进展[J].中国中医骨伤科杂志,2017,29(10):75-77.
[29]张顺聪,郭惠智,莫凌,等.斜外侧椎间融合术联合后路固定治疗腰椎退变性疾病的初步评价[J].中国矫形外科杂志,2018,26(3):203-208.
[30]秦世强,孙宇庆,倪文卓,等.OLIF与TLIF治疗退变性腰椎滑脱合并腰椎管狭窄症的疗效对比[J].实用骨科杂志,2018,24(7):628-632.
[31]沈俊宏,王建,刘超,等.斜外侧腰椎椎间融合术治疗单节段腰椎退变性疾病的近期疗效[J].中华骨科杂志,2017,37(16):997-1005.
[32]陆生林.退变性腰椎滑脱的手术治疗进展[J].中国现代药物应用,2010,4(17):223-225.
[2]Herkowitz HN,Kurz LT,Overholt DP.Surgical management of cervical soft disc herniation.A comparison between the anterior and posterior approach[J].Spine(Phila Pa 1976),1990,15(10):1026-1030.
[3]Lurie JD,Tosteson TD,Tosteson A,et al.Long-term outcomes of lumbar spinal stenosis:Eight-year results of the spine patient outcomes research trial(SPORT)[J].Spine(Phila Pa 1976),2015,40(2):63-76.
[4]艾比不拉·吐尔逊,苏比·亚力买买提.腰椎管狭窄及退变性腰椎滑脱手术治疗的研究进展[J].新疆医学,2016,46(7):873-876.
[5]丁浩,周孜辉,沈强,等.单纯减压与减压融合内固定术治疗Ⅰ度退行性滑脱腰椎椎管狭窄疗效对比分析[J].河北医学,2016,22(4):560-563.
[6]Mardjetko SM,Connolly PJ,Shott S.Degenerative lumbar spondylolisthesis.A meta-analysis of literature 1970-1993[J].Spine(Phila Pa 1976),1994,19(20 Suppl):2256-2265S.
[7]陈毅,崔新刚,吴恙,等.改良小切口肌间隙入路双侧固定单侧减压TILF手术临床疗效分析[J].中国临床解剖学杂志,2017,35(5):554-558.
[8]王建钧,李剑锋.单纯椎板减压与联合腰椎融合术治疗腰椎Ⅰ度滑脱并椎管狭窄效果的Meta分析[J].中国综合临床,2018,34(6):553-557.
[9]Eismont FJ,Norton RP,Hirsch BP.Surgical management of lumbar degenerative spondylolisthesis[J].J Am Acad Orthop Surg,2014,22(4):203-213.
[10]Herkowitz HN,Kurz LT.Degenerative lumbar spondylolisthesis with spinal stenosis.A prospective study comparing decompression with decompression and intertransverse process arthrodesis[J].J Bone Joint Surg Am,1991,73(6):802-808.
[11]Martin CR,Gruszczynski AT,Braunsfurth HA,et al.The surgical management of degenerative lumbar spondylolisthesis:A systematic review[J].Spine(Phila Pa 1976),2007,32(16):1791-1798.
[12]在治疗腰椎管狭窄的方法中,手术减压加器械或非器械腰椎融合是否较单纯减压手术效果更佳?[C]//中华医学会骨科学分会.2007全国腰椎退行性疾患学术论坛论文集.青岛:中华医学会骨科学分会,2007:63-66.
[13]Schnake KJ,Schaeren S,Jeanneret B.Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis[J].Spine(Phila Pa 1976),2006,31(4):442-449.
[14]徐德太,谢洪波,彭明.腰椎非融合内固定术治疗老年稳定性腰椎退变性疾病近期疗效分析[J].当代医学,2018,24(2):106-108.
[15]曲扬,赵建武,董荣鹏,等.中老年稳定性腰椎退变性疾病的治疗策略--腰椎非融合内固定术[J].中国老年学杂志,2014,34(16):4520-4521.
[16]Sengupta DK,Herkowitz HN.Degenerative spondylolisthesis:Review of current trends and controversies[J].Spine(Phila Pa1976),2005,30(6 Suppl):S71-81.
[17]Hy K,Bünger C,Niederman B,et al.Transforaminal lumbar interbody fusion(TLIF)versus posterolateral instrumented fusion(PLF)in degenerative lumbar disorders:A randomized clinical trial with 2-year follow-up[J].Eur Spine J,2013,22(9):2022-2029.
[18]廖国平,邓芳文,孙德贵,等.后外侧腰椎融合术与后路椎间融合术比较治疗腰椎滑脱症疗效的Meta分析[J].临床医药实践,2016,25(4):259-267.
[19]Okuyama K,Kido T,Unoki E,et al.PLIF with a titanium cage and excised facet joint bone for degenerative spondylolisthesis-in augmentation with a pedicle screw[J].J Spinal Disord Tech,2007,20(1):53-59.
[20]王力,邱南海.腰椎滑脱的手术治疗进展[J].赣南医学院学报,2017,37(3):482-487.
[21]张烽,陈兵乾,居建文,等.TLIF、PLIF、ALIF三种椎间融合术后腰椎即刻稳定性的比较[J].江苏医药,2008,34(2):147-149.
[22]Ishihara H,Osada R,Kanamori M,et al.Minimum 10-year followup study of anterior lumbar interbody fusion for isthmic spondylolisthesis[J].J Spinal Disord,2001,14(2):91-99.
[23]刘新宇,原所茂,田永昊,等.两种经椎间孔椎体间融合治疗单节段腰椎退行性疾病的疗效比较[J].中华创伤杂志,2015,31(6):507-511.
[24]Humphreys SC,Hodges SD,Patwardhan AG,et al.Comparison of posterior and transforaminal approaches to lumbar interbody fusion[J].Spine(Phila Pa 1976),2001,26(5):567-571.
[25]顾祖超,张宇,李果,等.经椎间孔与经后外侧入路椎间融合术治疗退变性腰椎滑脱症的疗效比较[J].脊柱外科杂志,2017,15(4):200-205.
[26]Silvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion:Oblique lumbar interbody fusion in 179 patients[J].Asian Spine J,2012,6(2):89-97.
[27]沈俊宏,王建,刘超,等.斜外侧腰椎间融合术治疗退变性腰椎疾病的并发症和早期临床结果[J].中国脊柱脊髓杂志,2018,28(5):397-404.
[28]徐彬,徐峰,李涛,等.腰椎滑脱症的微创手术治疗进展[J].中国中医骨伤科杂志,2017,29(10):75-77.
[29]张顺聪,郭惠智,莫凌,等.斜外侧椎间融合术联合后路固定治疗腰椎退变性疾病的初步评价[J].中国矫形外科杂志,2018,26(3):203-208.
[30]秦世强,孙宇庆,倪文卓,等.OLIF与TLIF治疗退变性腰椎滑脱合并腰椎管狭窄症的疗效对比[J].实用骨科杂志,2018,24(7):628-632.
[31]沈俊宏,王建,刘超,等.斜外侧腰椎椎间融合术治疗单节段腰椎退变性疾病的近期疗效[J].中华骨科杂志,2017,37(16):997-1005.
[32]陆生林.退变性腰椎滑脱的手术治疗进展[J].中国现代药物应用,2010,4(17):223-225.