Olinger A, Vollmar B, Hildebrandt U, Menger M D
Department of Trauma Surgery, University of Saarland, D-66421 Homburg/Saar, Germany.
Surg Endosc. 2000 Sep;14(9):844-8. doi: 10.1007/s004640000221.
Using a porcine model, this study describes the feasibility of a lumboendoscopically guided approach to the lumbar spine for anterior interbody fusion, and compares the results with that of the open procedure. The objectives of this study were to develop a minimally invasive approach to the lumbar spine for anterior fusion in pigs, and to test the validity and safety of the procedure in this porcine model. Besides posterior stabilization, considerable number of thoracolumbar spine (Th12-L5) fractures require intervention for anterior fusion to prevent loss of height of the injured segment and kyphotic deformation. Because anterior fusion needs major surgery (thoracophrenolumbotomy for Th12-L1), which is associated with high morbidity, this study aimed to develop a less traumatic minimally invasive approach.
Six pigs under balanced anesthesia were used to study the feasibility of the lumboendoscopic approach for bisegmental fusion (iliac crest bone block and dynamic compression plate) from Th15 to L6. In an additional six animals, lumboendoscopic fusion was performed at the level of diaphragm insertion (Th14-Th16), representing Th12-L1 in patients. For comparative analysis, six animals undergoing open thoracophrenolumbotomy and anterior Th14-Th16 fusion served as control subjects.
Endoscopic anterior fusion could be successfully performed at all levels of the thoracolumbar spine without major complications. In three cases, unintended opening of the peritoneal cavity was observed, however, without the operative procedure being affected. Comparative analysis revealed a significantly longer p < 0.01 operation time (126 +/- 6.5 min) and increased femoral vein pressure (11.3 +/- 0.7 mmHg) in animals undergoing endoscopic surgery (open procedure, 76.0 +/- 11.6 min and 5.2 +/- 0.5 mmHg). However, the microvascular blood supply (perfusion) to the distal extremities, as assessed by laser Doppler flowmetry, was not affected.
Our study demonstrates that lumboendoscopic anterior spine fusion in pigs is feasible at all levels from Th14 to L6, and can be performed in an acceptable operation time without major complications.
本研究采用猪模型，描述经腰内镜引导入路至腰椎进行前路椎间融合术的可行性，并将结果与开放手术进行比较。本研究的目的是开发一种用于猪腰椎前路融合的微创方法，并在该猪模型中测试该手术的有效性和安全性。除了后路稳定外，相当数量的胸腰椎（T12-L5）骨折需要进行前路融合干预，以防止受伤节段高度丢失和后凸畸形。由于前路融合需要进行大手术（T12-L1行胸腹腰椎切开术），且发病率较高，因此本研究旨在开发一种创伤较小的微创方法。
使用6只处于平衡麻醉状态的猪，研究经腰内镜入路从T15至L6进行双节段融合（髂嵴骨块和动力加压钢板）的可行性。另外6只动物在膈肌附着水平（T14-T16）进行经腰内镜融合，相当于患者的T12-L1。为进行比较分析，6只接受开放胸腹腰椎切开术和T14-T16前路融合的动物作为对照。
在胸腰椎的所有节段均可成功进行内镜下前路融合，无重大并发症。有3例观察到意外打开腹腔，但未影响手术操作。比较分析显示，接受内镜手术的动物手术时间显著延长（p<0.01，126±6.5分钟），股静脉压力升高（11.3±0.7mmHg）（开放手术为76.0±11.6分钟和5.2±0.5mmHg）。然而，通过激光多普勒血流仪评估，远端肢体的微血管血供（灌注）未受影响。
我们的研究表明，猪经腰内镜前路脊柱融合术在T14至L6的所有节段均可行，且可在可接受的手术时间内完成，无重大并发症。
