目的 探讨以腰椎前纵韧带外侧缘为参考，极外侧入路腰椎间融合手术（extreme lateral interbody fusion，XLIF）中融合器放置位置的准确性。 方法 前瞻性研究广州医科大学附属第三医院脊柱外科2019年1月至2021年2月实施的66例XLIF手术患者，随机分为融合器放置常规定位组（术中C臂定位）33例和改良定位组（术中C臂结合前纵韧带定位）33例，比较两组的基本临床特点，术后融合器所在的位置，以及围手术期并发症发生情况。 结果 共对114个腰椎节段进行了XLIF手术治疗，两组病例的基本临床资料比较无统计学差异（P>0.05）。依据本研究建立的融合器位置评价法比较发现，改良定位组能明显降低融合器放置偏前或偏后的情况（P<0.00）。围手术期并发症统计，两组均有髂腰肌乏力或大腿前外侧麻木的记录，但均未出现重要神经、血管及内脏损伤；常规定位组出现1例因融合器位置偏后需要二次手术减压。 结论 以前纵韧带外侧缘与纤维环的交界确定为融合器放置的前界可以提高融合器放置的精准性，有效防止融合器放置偏前或偏后，这在XLIF的临床应用中具有重要指导意义。
Abstract
Objective To investigate the accuracy of the cage placement in the extreme lateral interbody fusion (XLIF) approach with reference to the lateral boundary of the anterior longitudinal ligament in lumbar spine. Methods Sixty-six patients admitted to the Department of Spine Surgery, the Third Affiliated Hospital of Guangzhou Medical University from January 2019 to February 2021 were prospectively collected. All the patients were undergone the XLIF surgery in the lumbar spine. Thirty-three cases were randomly assigned into a regular decision group, and the placement of cage was determined by the intraoperative C-arm images. Another thirty-three cases were into the improved decision group, and the placement of cage was also determined by the intraoperative C-arm images. Meanwhile, the cage should be placed closely against the lateral boundary of the anterior longitudinal ligament. The basic clinical characteristics and the location of cage in each lumbar segment were compared between the two groups, and the occurrence of perioperative complications in both groups were also recorded. Results A total of 114 lumbar segments were treated by XLIF approach, and there were no significant differences in the baseline characteristic between the two groups (P>0.05). The cages in the improved decision group were significantly more centrally located than that in the regular decision group (P<0.00). Although the perioperative complications, including weakness of iliopsoas muscle and anterolateral thigh numbness, were recorded in both groups, no other neurological complications, no major vascular injuries, and nobowel perforations occurred in either group. There was only one case required a second surgical neural decompression due to the backward position of the cage in the regular decision group. Conclusions The junction between the lateral part of the anterior longitudinal ligament and lumbar annulus can be determined as the anterior boundary of the cage placement, which can improve the accuracy of the cage placement and effectively prevent the cage placement from deviating to the anterior or posterior, which has important guiding significance in the clinical application of XLIF.
关键词
极外侧入路腰椎间融合手术 /
前纵韧带 /
融合器的位置
Key words
Extreme lateral interbody fusion（XLIF） /
Anterior longitudinal ligament /
Cage placement
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参考文献
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基金
国家自然科学基金（82072409）；广东省自然科学基金（2019A1515012020）
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