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经皮侧方腰椎体间融合术治疗伴根性症状的腰椎骨折:使用骨替代物进行植骨融合。

Lateral Lumbar Interbody Fusion Using Bone Graft Substitute for Lumbar Vertebral Fracture Associated Radiculopathy.

机构信息

Department of Neurosurgery and Spine Surgery, Iseikai Hospital.

Department of Neurosurgery, Osaka University Graduate School of Medicine.

出版信息

Neurol Med Chir (Tokyo). 2022 Jul 15;62(7):342-346. doi: 10.2176/jns-nmc.2021-0395. Epub 2022 May 25.

Abstract

This study aims to present our surgical technique of lateral lumbar interbody fusion (LLIF) without corpectomy for lumbar vertebral fracture (LVF) associated radiculopathy. This study includes three patients treated with LLIF (mean age of 77.3 years, Group L) and three patients treated with PLIF (mean age of 75.7 years, Group P) to compare the surgical outcomes. The cartilage on the fractured vertebrae was aggressively resected with attention to avoid injury to the ring apophysis. The central cavity of the fractured endplate was filled with a bone graft substitute made of hydroxyapatite and collagen composite, followed by interbody fusion achieved by utilizing of a cage with sufficient length spanning the bilateral edges of the fractured vertebra. PLIF was performed with a standard technique using two interbody cages, and vertebroplasty was combined in one patient. Comparing to PLIF, LLIF could be performed with less estimated blood loss in shorter surgical time. Local kyphotic angle improved in all cases of Group L immediately after the surgery, but correction loss was observed at the final examination. The lordotic angle was lost in Group P postoperatively. Arthrodesis was achieved in all the cases. The mean VAS score for leg pain was 85.3 mm in Group L and 82.0 mm in Group P at preoperation and decreased to 8.7 mm and 11.3 mm, respectively, at postoperation. LLIF is an effective surgical option that enables stabilization of the fractured vertebra and reduces radicular pain by indirect neural decompression.

摘要

本研究旨在介绍我们在不进行椎体切除的情况下通过侧方腰椎椎间融合术(LLIF)治疗腰椎骨折(LVF)合并根性病变的手术技术。本研究纳入了 3 例接受 LLIF 治疗的患者(平均年龄 77.3 岁,L 组)和 3 例接受 PLIF 治疗的患者(平均年龄 75.7 岁,P 组),以比较手术结果。积极切除骨折椎骨上的软骨,注意避免损伤环突。用羟基磷灰石和胶原复合材料制成的骨移植替代物填充骨折终板的中央腔,然后通过使用足够长度的椎间融合器跨越骨折椎体的双侧边缘来实现椎间融合。PLIF 采用标准技术,使用两个椎间融合器,并在 1 例患者中联合使用椎体成形术。与 PLIF 相比,LLIF 可在更短的手术时间内减少估计失血量。L 组所有患者术后局部后凸角立即改善,但在最终检查时观察到矫正丢失。P 组术后后凸角丢失。所有患者均实现了融合。L 组术前腿痛的平均视觉模拟评分(VAS)为 85.3mm,术后为 8.7mm;P 组术前腿痛的平均 VAS 为 82.0mm,术后为 11.3mm。LLIF 是一种有效的手术选择,可通过间接神经减压稳定骨折椎体并减轻神经根性疼痛。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70bc/9357453/8ec523a3feb8/1349-8029-62-0342-g001.jpg

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