Huang Chien-Yuan, Yeh Kuang-Ting, Yu Tzai-Chiu, Lee Ru-Ping, Chen Ing-Ho, Peng Cheng-Huan, Liu Kuan-Lin, Wang Jen-Hung, Wu Wen-Tien
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2018 Jan-Mar;30(1):20-23. doi: 10.4103/tcmj.tcmj_186_17.
Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach.
From June 2008 to 2012, 20 patients who had L5-S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS) and the patient's Oswestry Disability Index (ODI) score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films.
The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases.
The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.
通过前路或后路进行腰骶融合以实现良好的腰椎前凸和稳定性一直是一项具有挑战性的外科手术，并且与其他腰椎节段相比，假关节形成率往往更高。本研究评估了通过前后联合入路实现的腰骶融合的临床和影像学结果。
2008年6月至2012年，连续治疗20例L5 - S1不稳定和狭窄患者，首先通过经腹直肌旁入路使用同种异体支撑骨移植进行前路椎间融合，然后进行后路椎弓根螺钉固定。进行了至少1年的临床和影像学随访。记录术中失血量、手术时间以及任何与手术相关的并发症。使用视觉模拟量表（VAS）和患者的Oswestry功能障碍指数（ODI）评分评估临床结果。1年后，通过静态平片分析骨盆入射角、腰椎前凸和节段性前凸评估影像学结果，同时使用动态平片评估融合稳定性。
平均手术时间和失血量分别为215分钟和325毫升。1年后，VAS和ODI评分显著改善，所有病例均获得了具有良好前凸曲度的稳定融合。
联合手术的手术结果在功能和影像学结果方面令人满意。我们的方法在前路融合和后路固定方面均具有优势。
