AxiaLIF在腰骶椎融合治疗中的应用
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摘要
背景:腰骶椎融合手术是治疗腰骶椎退行性疾病的重要方法,而传统的开放融合手术创伤较大、术后康复时间较长、并发症较多,为了减少对正常组织的损伤和提高愈合率,国内外学者对腰椎融合手术进行改良,腰椎融合微创手术的发展成为一种趋势。2004年Cragg提出经骶骨前入路经皮腰骶椎轴向融合术(Axia LIF),该术式是经直肠后壁和骶前间隙入路,轴向置钉,对L5/S1进行融合,保留了脊柱重要的肌肉、韧带血管等结构的完整,与传统的融合手术有相似的力学稳定性,手术节段的骨性融合率高等优点,符合脊柱微创手术的理念。目的:综述国内外文献,从传统腰椎融合和目前腰椎融合角度总结其优势与不足,并探讨Axia LIF在腰骶椎融合手术治疗中的应用进展。方法:以"Axial interbody fusion and(properties or evaluation),biomechanics,spine mechanical test,spine and(kinematics or motion)"为英文检索词检索Pub Med,Web of Science,Springer数据库,以"轴向融合,生物力学研究评估,生物力学,骶骨前间隙,脊柱微创"为检索词检索中文期刊全文数据库,纳入腰椎融合术及并发症、生物力学、人文医学等相关文献,主要整理近5年来该领域内的经典文献,排除重复性工作,重点对46篇文献进行分析讨论。结果与结论:近90年来国内外学者从各个层面对腰椎融合手术的方式展开了研究,分析和总结各种术式的优缺点,明确了腰椎疾病融合手术的指征。文章通过综述性对比开放手术和微创手术的特点,表明目前腰椎融合微创手术已成为一种发展趋势,对Axia LIF术后生物力学稳定性、并发症、术后康复时间等方面的深入了解,在未来的医学研究道路上,仍旧任重而道远。
BACKGROUND: Lumbosacral vertebral fusion operation is an important treatment for lumbosacral vertebral degenerative disease. Traditional open surgery has great trauma; postoperative recovery time is longer; there are more complications. To reduce the damage to normal tissue and increase the rate of healing, scholars in and outside China improve the lumbar spine fusion surgery, and lumbar fusion becomes a tendency of the development of minimally invasive surgery. In 2004, Cragg introduced lumbosacral vertebral axial fusion(Axia LIF, axial lumbar intervertebral fusion). The operation is through posterior rectal wall and presacral space approach, axially nailing for fusion of L5/S1. Muscle, ligament and blood vessels of the spine were retained. Mechanical stability was similar to that of traditional fusion. Osseous fusion rate was high at the operation segment. This is in line with the concept of minimally invasive surgery of the spine. OBJECTIVE: To summarize the advantages and disadvantages of traditional and present fusion techniques from traditional lumbar fusion and present lumbar fusion angle, and to explore the application of Axia LIF in lumbosacral fusion. METHODS: We retrieved Pub Med, Web of Science, and Springer database with the English key words of "Axial interbody fusion and(properties or evaluation), biomechanics, spine mechanical test, spine and(kinematics or motion)", and Chinese Journal Full-Text Database with the Chinese key words of "Axial fusion, biomechanics research assessment, biomechanics, anterior sacral space, minimally invasive spine" for studies concerning lumbar fusion, complications, biomechanics, and humanistic medicine that had been published in recent 5 years. Repetitive studies were excluded, and 46 studies were analyzed and discussed. RESULTS AND CONCLUSION: In the past 90 years, scholars in and outside China had studied the methods of lumbar fusion from various levels, analyzed and summarized the advantages and disadvantages of various operative methods, and identified the indications of lumbar spinal fusion. By comparing characteristics of open surgery and minimally invasive surgery, this study suggested that minimally invasive lumbar fusion has become a trend. In-depth understanding of biomechanical stability, complications, and postoperative recovery time after Axia LIF is still a long way to go in future medical research.
BACKGROUND: Lumbosacral vertebral fusion operation is an important treatment for lumbosacral vertebral degenerative disease. Traditional open surgery has great trauma; postoperative recovery time is longer; there are more complications. To reduce the damage to normal tissue and increase the rate of healing, scholars in and outside China improve the lumbar spine fusion surgery, and lumbar fusion becomes a tendency of the development of minimally invasive surgery. In 2004, Cragg introduced lumbosacral vertebral axial fusion(Axia LIF, axial lumbar intervertebral fusion). The operation is through posterior rectal wall and presacral space approach, axially nailing for fusion of L5/S1. Muscle, ligament and blood vessels of the spine were retained. Mechanical stability was similar to that of traditional fusion. Osseous fusion rate was high at the operation segment. This is in line with the concept of minimally invasive surgery of the spine. OBJECTIVE: To summarize the advantages and disadvantages of traditional and present fusion techniques from traditional lumbar fusion and present lumbar fusion angle, and to explore the application of Axia LIF in lumbosacral fusion. METHODS: We retrieved Pub Med, Web of Science, and Springer database with the English key words of "Axial interbody fusion and(properties or evaluation), biomechanics, spine mechanical test, spine and(kinematics or motion)", and Chinese Journal Full-Text Database with the Chinese key words of "Axial fusion, biomechanics research assessment, biomechanics, anterior sacral space, minimally invasive spine" for studies concerning lumbar fusion, complications, biomechanics, and humanistic medicine that had been published in recent 5 years. Repetitive studies were excluded, and 46 studies were analyzed and discussed. RESULTS AND CONCLUSION: In the past 90 years, scholars in and outside China had studied the methods of lumbar fusion from various levels, analyzed and summarized the advantages and disadvantages of various operative methods, and identified the indications of lumbar spinal fusion. By comparing characteristics of open surgery and minimally invasive surgery, this study suggested that minimally invasive lumbar fusion has become a trend. In-depth understanding of biomechanical stability, complications, and postoperative recovery time after Axia LIF is still a long way to go in future medical research.
引文
[1]Gerszten PC,Tobler WD,Nasca RJ.Retrospective analysis of L5-S1 axial lumbar interbody fusion(Axia LIF):a comparison with and without the use of recombinant human bone morphogenetic protein-2.Spine J.2011;11:1027-1032.
[2]Vibert BT,Sliva CD,Herkowitz HN.Treatment of instability and spondylolisthesis:surgical versus nonsurgical treatment.Clin Orthop Relat Res.2006;443:222-227.
[3]Chen D,Fay LA,Lok J,et al.Increasing neuroforaminal volume by anterior interbody distraction in degenerative lumbar spine.Spine(Phila Pa 1976).1995;20:74-79.
[4]Vamvanij V,Ferrara LA,Hai Y,et al.Quantitative changes in spinal canal dimensions using interbody distraction for spondylolisthesis.Spine(Phila Pa 1976).2001;26:E13-E18.
[5]Cragg A,Carl A,Casteneda F.New percutaneous access method for minimally invasive anterior lumbosacral surgery.J Spinal Disord Tech.2004;17(1):21-28.
[6]Marotta N,Cosar M,Pimenta L,et al.A novel minimally invasiveresacral approach and instrumentation technique for anterior L5-S1,intervertehral discectomy and fusion.Neurosurg Focus.2006;20(1):E9.
[7]Aryan HE,Newman CB,Gold JJ,et al.Percutaneous axial lumbar interbody fusion(Axia LIF)of the L5-S1 segment:initial clinical and radiographic experience.Minim Invasive Neurosurg.2008;51(4):225-230.
[8]Fleischer GD,Kim YJ,Ferrara LA,et al.Biomechanical analysis ofsacral screw strain and range of motion in long posterior spinal fixation constructs:effects of lumbosacral fixation strategies in reducing sacral screw strains.Spine.2012;37(3):163-169.
[9]戎利民,董健文,刘斌,等.轴向椎体间融合术微创治疗腰骶椎失稳症[J].中华显微外科杂志,2009,32(1):15-18.
[10]宋西正,王文军,薛静波,等.经骶前间隙轴向椎间融合联合内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病[J].中国脊柱脊髓杂志,2013,23(9):778-782.
[11]宋西正.经骶前间隙轴向椎间融合术联合显微内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病[A].中国中西医结合学会脊柱医学专业委员会、《中国骨伤》杂志.中国中西医结合学会脊柱医学专业委员会第五届学术年会暨第二届专业委员会换届选举会议论文集[C].中国中西医结合学会脊柱医学专业委员会、《中国骨伤》杂志,2012.
[12]Burns BH.An operation for spondylolisthesis.Lancet.1933;1:1233.
[13]Vamvanij V,Ferrara LA,Hai Y,et al.Quantitative changes in spinal canal dimensions using interbody distraction for spondylolisthesis.Spine(Phila Pa 1976).2001;26:E13-E18.
[14]Fantini GA,Pappou IP,Girardi FP,et al.Major vascular injury during anterior lumbar spinal surgery:incidence,risk factors,and management.Spine(Phila Pa1976).2007;32:2751-2758.
[15]Hsieh PC,Koski TR,O’Shaughnessy BA,et al.Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion:implications for the restoration of foraminal height,local disc angle,lumbar lordosis,and sagittal balance.J Neurosurg Spine.2007;7:379-386.
[16]Fantini GA,Pappou IP,Girardi FP,et al.Major vascular injury during anterior lumbar spinal surgery:incidence,risk factors,and management.Spine(Phila Pa 1976).2007;32:2751-2758.
[17]Sasso RC,Kenneth Burkus J,Le Huec JC.Retrograde ejaculation after anterior lumbar interbody fusion:transperitoneal versus retroperitoneal exposure.Spine(Phila Pa 1976).2003;28:1023-1026.
[18]Cloward RB.The treatment of ruptured lumbar intervertebral discs by vertebral body fusion:indications,operative technique,after care.J Neurosurg.1953;10:154-168.
[19]Jutte PC,Castelein RM.Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations.Eur Spine J.2002;11(6):594-598.
[20]Di Paola CP,Molinari RW.Posterior lumbar interbody fusion.J Am Acad Orthop Surg.2008;16:130-139.
[21]Pimenta L.Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery.VIII Brazilian Spine Society Meeting.
[22]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 179patients.Asian Spine J.2012;6(2):89-97.
[23]Kubota G,Orita S,Umimura T,et al.Insidious intraoperative ureteral injury as a complication in oblique lumbar interbody fusion surgery:a case report.BMC Res Notes.2017;10:193.
[24]Yeung AT.The evolution of percutaneous spinal endoscopy and discectomy:state of the art.Mt Sinai J Med.2000;67:327-332.
[25]Foley KT,Holly LT,Schwender JD.Minimally invasive lumbar fusion.Spine.2003;28(15S):S26-S35.
[26]Xue H,Tu Y,Cai M.Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases.The Spine J.2012;12(3):209-215.
[27]Chen HH,Cheung HH,Wang WK,et al.Biomechanical analysis of unilateral fixation with interbody cages.Spine.2005;30(4):E92-E96.
[28]Suk KS,Lee HM,Kim NH,et al.Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion.Spine.2000;25(14):1843-1847.
[29]Ledet EH,Tymeson MP,Salerno S,et al.Biomechanical evaluation of a novel lumbosacral axial fixation device.J Biomech Eng.2005;127(6):929-933.
[30]徐宏光,杨晓明,吴天亮,等.经皮前路腰骶融合螺钉的有限元分析[J].中华医学杂志,2010,90(3):153-156.
[31]Erkan S,Wu C,Mehbod AA,et al.Biomechanical evaluation of a new Axia LIF technique for two-level lumbar fusion.Eur Spine J.2009;18(6):807-814.
[32]Akesen B,Wu C,Mehbod AA,et al.Biomechanical evaluation of paracoccygealtranssacral fixation.J Spinal Disord Tech.2008;21(1):39-44.
[33]戎利民,董健文,刘斌,等.轴向椎体间融合术微创治疗腰骶椎失稳症[J].中华显微外科杂志,2009,32(1):15-18.
[34]Marawar S,Ordway N,Jung J,et al.Changes in neuroforaminal height with 2 level axial presacral lumbar interbody fusion at L4-S1.J Spine Surg.2014.
[35]Patil SS,Lindley EM,Patel VV,et al.Clinical and radiological outcomes of axial lumbar interbody fusion.Orthopedics.2010;33(12):883.
[36]刘栋梁.腰骶椎带刺内锁轴向融合内固定的有限元分析[D].南华大学,2017.
[37]Tobler WD,Ferrara LA.The presacral retroperitoneal approach for axial lumbar interbody fusion:a prospective study of clinical outcomes,complications and fusion rates at a follow-up of two years in 26 patients.J Bone Joint Surg Br.2011;93:955-960.
[38]Tobler WD,Gerszten PC,Bradley WD,et al.Minimally invasive axial presacral L5-S1 interbody fusion:two-year clinical and radiographic outcomes.Spine(Phila Pa 1976).2011;36:E1296-E1301.
[39]Gerszten PC,Tobler W,Raley TJ,et al.Axial presacral lumbar interbody fusion and percutaneous posterior fixation for stabilization of lumbosacral isthmic spondylolisthesis.J Spinal Disord Tech.2012;25:E36-E40.
[40]Anand N,Baron EM,Thaiyananthan G,et al.Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis:a technique and feasibility study.J Spinal Disord Tech.2008;21:459-467.
[41]Issack PS,Boachie-Adjei O.Axial lumbosacral interbody fusion appears safe as a method to obtain lumbosacral arthrodesis distal to long fusion constructs.HSS J.2012;8:116-121.
[42]Botolin S,Agudelo J,Dwyer A,et al.High rectal injury during trans-1 axial lumbar interbody fusion L5-S1 fixation:a case report.Spine(Phila Pa 1976).2010;35:E144-E148.
[43]Mazur MD,Duhon BS,Schmidt MH,et al.Rectal perforation after Axia LIF instrumentation:case report and review of the literature.Spine J.2013;13:e29-e34.
[44]Hofstetter CP,Shin B,Tsiouris AJ,et al.Radiographic and clinical outcome after 1-and 2-level transsacral axial interbody fusion.Clinical article.J Neurosurg Spine.2013;19:454-463.
[45]Marchi L,Oliveira L,Coutinho E,et al.Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up.Clinical article.J Neurosurg Spine.2012;17:187-192.
[46]邱贵兴.以人为本,发展骨科[J].中华外科杂志,2009,47(1):4-6.
[2]Vibert BT,Sliva CD,Herkowitz HN.Treatment of instability and spondylolisthesis:surgical versus nonsurgical treatment.Clin Orthop Relat Res.2006;443:222-227.
[3]Chen D,Fay LA,Lok J,et al.Increasing neuroforaminal volume by anterior interbody distraction in degenerative lumbar spine.Spine(Phila Pa 1976).1995;20:74-79.
[4]Vamvanij V,Ferrara LA,Hai Y,et al.Quantitative changes in spinal canal dimensions using interbody distraction for spondylolisthesis.Spine(Phila Pa 1976).2001;26:E13-E18.
[5]Cragg A,Carl A,Casteneda F.New percutaneous access method for minimally invasive anterior lumbosacral surgery.J Spinal Disord Tech.2004;17(1):21-28.
[6]Marotta N,Cosar M,Pimenta L,et al.A novel minimally invasiveresacral approach and instrumentation technique for anterior L5-S1,intervertehral discectomy and fusion.Neurosurg Focus.2006;20(1):E9.
[7]Aryan HE,Newman CB,Gold JJ,et al.Percutaneous axial lumbar interbody fusion(Axia LIF)of the L5-S1 segment:initial clinical and radiographic experience.Minim Invasive Neurosurg.2008;51(4):225-230.
[8]Fleischer GD,Kim YJ,Ferrara LA,et al.Biomechanical analysis ofsacral screw strain and range of motion in long posterior spinal fixation constructs:effects of lumbosacral fixation strategies in reducing sacral screw strains.Spine.2012;37(3):163-169.
[9]戎利民,董健文,刘斌,等.轴向椎体间融合术微创治疗腰骶椎失稳症[J].中华显微外科杂志,2009,32(1):15-18.
[10]宋西正,王文军,薛静波,等.经骶前间隙轴向椎间融合联合内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病[J].中国脊柱脊髓杂志,2013,23(9):778-782.
[11]宋西正.经骶前间隙轴向椎间融合术联合显微内窥镜下后入路椎间盘摘除治疗腰骶椎退行性疾病[A].中国中西医结合学会脊柱医学专业委员会、《中国骨伤》杂志.中国中西医结合学会脊柱医学专业委员会第五届学术年会暨第二届专业委员会换届选举会议论文集[C].中国中西医结合学会脊柱医学专业委员会、《中国骨伤》杂志,2012.
[12]Burns BH.An operation for spondylolisthesis.Lancet.1933;1:1233.
[13]Vamvanij V,Ferrara LA,Hai Y,et al.Quantitative changes in spinal canal dimensions using interbody distraction for spondylolisthesis.Spine(Phila Pa 1976).2001;26:E13-E18.
[14]Fantini GA,Pappou IP,Girardi FP,et al.Major vascular injury during anterior lumbar spinal surgery:incidence,risk factors,and management.Spine(Phila Pa1976).2007;32:2751-2758.
[15]Hsieh PC,Koski TR,O’Shaughnessy BA,et al.Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion:implications for the restoration of foraminal height,local disc angle,lumbar lordosis,and sagittal balance.J Neurosurg Spine.2007;7:379-386.
[16]Fantini GA,Pappou IP,Girardi FP,et al.Major vascular injury during anterior lumbar spinal surgery:incidence,risk factors,and management.Spine(Phila Pa 1976).2007;32:2751-2758.
[17]Sasso RC,Kenneth Burkus J,Le Huec JC.Retrograde ejaculation after anterior lumbar interbody fusion:transperitoneal versus retroperitoneal exposure.Spine(Phila Pa 1976).2003;28:1023-1026.
[18]Cloward RB.The treatment of ruptured lumbar intervertebral discs by vertebral body fusion:indications,operative technique,after care.J Neurosurg.1953;10:154-168.
[19]Jutte PC,Castelein RM.Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations.Eur Spine J.2002;11(6):594-598.
[20]Di Paola CP,Molinari RW.Posterior lumbar interbody fusion.J Am Acad Orthop Surg.2008;16:130-139.
[21]Pimenta L.Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery.VIII Brazilian Spine Society Meeting.
[22]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 179patients.Asian Spine J.2012;6(2):89-97.
[23]Kubota G,Orita S,Umimura T,et al.Insidious intraoperative ureteral injury as a complication in oblique lumbar interbody fusion surgery:a case report.BMC Res Notes.2017;10:193.
[24]Yeung AT.The evolution of percutaneous spinal endoscopy and discectomy:state of the art.Mt Sinai J Med.2000;67:327-332.
[25]Foley KT,Holly LT,Schwender JD.Minimally invasive lumbar fusion.Spine.2003;28(15S):S26-S35.
[26]Xue H,Tu Y,Cai M.Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases.The Spine J.2012;12(3):209-215.
[27]Chen HH,Cheung HH,Wang WK,et al.Biomechanical analysis of unilateral fixation with interbody cages.Spine.2005;30(4):E92-E96.
[28]Suk KS,Lee HM,Kim NH,et al.Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion.Spine.2000;25(14):1843-1847.
[29]Ledet EH,Tymeson MP,Salerno S,et al.Biomechanical evaluation of a novel lumbosacral axial fixation device.J Biomech Eng.2005;127(6):929-933.
[30]徐宏光,杨晓明,吴天亮,等.经皮前路腰骶融合螺钉的有限元分析[J].中华医学杂志,2010,90(3):153-156.
[31]Erkan S,Wu C,Mehbod AA,et al.Biomechanical evaluation of a new Axia LIF technique for two-level lumbar fusion.Eur Spine J.2009;18(6):807-814.
[32]Akesen B,Wu C,Mehbod AA,et al.Biomechanical evaluation of paracoccygealtranssacral fixation.J Spinal Disord Tech.2008;21(1):39-44.
[33]戎利民,董健文,刘斌,等.轴向椎体间融合术微创治疗腰骶椎失稳症[J].中华显微外科杂志,2009,32(1):15-18.
[34]Marawar S,Ordway N,Jung J,et al.Changes in neuroforaminal height with 2 level axial presacral lumbar interbody fusion at L4-S1.J Spine Surg.2014.
[35]Patil SS,Lindley EM,Patel VV,et al.Clinical and radiological outcomes of axial lumbar interbody fusion.Orthopedics.2010;33(12):883.
[36]刘栋梁.腰骶椎带刺内锁轴向融合内固定的有限元分析[D].南华大学,2017.
[37]Tobler WD,Ferrara LA.The presacral retroperitoneal approach for axial lumbar interbody fusion:a prospective study of clinical outcomes,complications and fusion rates at a follow-up of two years in 26 patients.J Bone Joint Surg Br.2011;93:955-960.
[38]Tobler WD,Gerszten PC,Bradley WD,et al.Minimally invasive axial presacral L5-S1 interbody fusion:two-year clinical and radiographic outcomes.Spine(Phila Pa 1976).2011;36:E1296-E1301.
[39]Gerszten PC,Tobler W,Raley TJ,et al.Axial presacral lumbar interbody fusion and percutaneous posterior fixation for stabilization of lumbosacral isthmic spondylolisthesis.J Spinal Disord Tech.2012;25:E36-E40.
[40]Anand N,Baron EM,Thaiyananthan G,et al.Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis:a technique and feasibility study.J Spinal Disord Tech.2008;21:459-467.
[41]Issack PS,Boachie-Adjei O.Axial lumbosacral interbody fusion appears safe as a method to obtain lumbosacral arthrodesis distal to long fusion constructs.HSS J.2012;8:116-121.
[42]Botolin S,Agudelo J,Dwyer A,et al.High rectal injury during trans-1 axial lumbar interbody fusion L5-S1 fixation:a case report.Spine(Phila Pa 1976).2010;35:E144-E148.
[43]Mazur MD,Duhon BS,Schmidt MH,et al.Rectal perforation after Axia LIF instrumentation:case report and review of the literature.Spine J.2013;13:e29-e34.
[44]Hofstetter CP,Shin B,Tsiouris AJ,et al.Radiographic and clinical outcome after 1-and 2-level transsacral axial interbody fusion.Clinical article.J Neurosurg Spine.2013;19:454-463.
[45]Marchi L,Oliveira L,Coutinho E,et al.Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up.Clinical article.J Neurosurg Spine.2012;17:187-192.
[46]邱贵兴.以人为本,发展骨科[J].中华外科杂志,2009,47(1):4-6.