轴向腰椎体间融合术（AxiaLIF）治疗成人脊柱侧弯。
Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis.
机构信息
Hospital for Special Surgery, 525 East 71st Street, #9J, New York, NY 10021, USA.
出版信息
Eur Spine J. 2013 Mar;22 Suppl 2(Suppl 2):S225-31. doi: 10.1007/s00586-012-2351-7. Epub 2012 May 10.
BACKGROUND
AxiaLIF was initially advocated as a minimally invasive, presacral lumbar fusion approach. Its use has expanded in to adult scoliosis surgeries.
METHODS
Current literature about AxiaLIF for degenerative lumbar surgery and adult scoliosis surgery were reviewed. Anatomy, biomechanical properties, clinical results, and complications were summarized.
RESULTS
Anatomically, AxiaLIF is relatively safe even though traversing blood vessels, and the pelvic splanchnic nerve can be at risk. AxiaLIF can provide significant stiffness compared to the intact spine, but posterior supplementation is recommended. AxiaLIF in the long construct for adult scoliosis surgeries can protect the S1 screw as effectively as pelvic fixation. Successful clinical outcomes after AxiaLIF were reported in the degenerative lumbar spine, adult scoliosis, and spondylolisthesis. It can facilitate a high fusion rate up to 96 % without BMP. Complications include pseudarthrosis, rectal injury, transient nerve irritation, and intrapelvic hematoma.
CONCLUSION
AxiaLIF is a relatively safe procedure, and it provides good clinical results in both short constructs and long constructs for adult scoliosis surgery. For a safer procedure, surgeons should seek out prior colorectal surgical history and review preoperative imaging studies carefully.
背景
AxiaLIF 最初被提倡为一种微创、经骶前路腰椎融合术。其应用已扩展到成人脊柱侧弯手术中。
方法
对 AxiaLIF 治疗退行性腰椎手术和成人脊柱侧弯手术的现有文献进行了回顾。总结了解剖学、生物力学特性、临床结果和并发症。
结果
从解剖学角度来看，即使穿过血管和骨盆内脏神经，AxiaLIF 也是相对安全的。与完整脊柱相比，AxiaLIF 可提供显著的刚度，但建议进行后补。对于成人脊柱侧弯手术的长节段，AxiaLIF 可像骨盆固定一样有效地保护 S1 螺钉。在退行性腰椎、成人脊柱侧弯和脊椎滑脱中，AxiaLIF 报告了成功的临床结果。它可以在不使用 BMP 的情况下实现高达 96%的高融合率。并发症包括假关节形成、直肠损伤、短暂性神经刺激和盆腔血肿。
结论
AxiaLIF 是一种相对安全的手术方法，在成人脊柱侧弯手术的短节段和长节段中均能提供良好的临床效果。为了更安全的手术，外科医生应寻找既往结直肠手术史，并仔细审查术前影像学研究。
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