中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (27): 4401-4407.doi: 10.12307/2023.629

• 骨与关节综述 bone and joint review • 上一篇    下一篇

内镜下经椎间孔腰椎椎间融合治疗腰椎退行性疾病：减压融合与保存脊柱后方的解剖结构

靳鑫杰，陆向东， 赵轶波，赵晓峰，齐德泰，赵  斌   

  1. 山西医科大学第二医院，山西省太原市   030000
  • 收稿日期:2022-03-02 接受日期:2022-08-15 出版日期:2023-09-28 发布日期:2022-11-08
  • 通讯作者: 赵斌，博士，主任医师，山西医科大学第二医院，山西省太原市 030000
  • 作者简介:靳鑫杰，男，1995年生，山西省长治市人，汉族，山西医科大学在读硕士。

Endoscopic transforaminal lumbar interbody fusion for degenerative diseases of the lumbar spine: decompression fusion and preservation of posterior spine anatomy

Jin Xinjie, Lu Xiangdong, Zhao Yibo, Zhao Xiaofeng, Qi Detai, Zhao Bin   

  1. Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • Received:2022-03-02 Accepted:2022-08-15 Online:2023-09-28 Published:2022-11-08
  • Contact: Zhao Bin, MD, Chief physician, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • About author:Jin Xinjie, Master candidate, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

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摘要：


文题释义：

腰椎退行性疾病：是指随着年龄的增长，腰椎老化退变而形成的一组疾病的总称，包括腰椎间盘突出症、腰椎椎管狭窄症、退变性腰椎侧弯、腰椎滑脱等，这些疾病都跟年龄增长有关系，统一称为腰椎退行性疾病。
学习曲线：是指在不断学习过程中逐步完成并熟练掌握某项操作的过程，包括快速上升期和平台期2个阶段，进入平台期即表示该项技术接近或达到相对成熟的状态。学习曲线可用于评价某项技术的难易程度，学习曲线短说明该项技术易于掌握。学习曲线通常以进入平台期所需的手术例数来衡量，其标志为手术时间逐渐缩短达到一个稳定状态，手术并发症少且疗效稳定。因此学习曲线最主要的指标是手术时间的长短，其他指标包括手术并发症、术中出血量、手术中转为开放手术等。

背景：腰椎退行性疾病是一种中老年患者的常见疾病，传统腰椎手术创伤较大，术后恢复时间长。近年来，脊柱内镜技术取得了很大的发展，内镜下经椎间孔腰椎椎间融合术作为腰椎退行性疾病的新型治疗手段，由于具有创伤小、恢复时间短、术后疼痛少、出血量少等优点，在具有适应证的腰椎退行性疾病患者中值得推广。
目的：文章回顾了内镜下经椎间孔腰椎椎间融合术在腰椎退行性疾病中的研究进展，综述内镜下经椎间孔腰椎椎间融合的发生发展、优势、局限及发展趋势等。
方法：第一作者应用计算机系统检索PubMed、Web of Science和万方数据库中2010-2022年出版的文献，英文检索词为“endoscopic lumbar fusion，lumbar degenerative disease，minimally invasive spine”；中文检索词为“内镜下腰椎融合术、腰椎退行性疾病、脊柱微创”。排除重复、质量较差及不相关的文献进行综述分析。
结果与结论：①腰椎退行性疾病是椎间盘突出、椎管狭窄、椎体滑脱等疾病的病理基础，是椎间盘源性下腰痛的主要病因。内镜下经椎间孔腰椎椎间融合术是一种治疗腰椎退行性疾病的新型微创技术。②近年来，内镜下腰椎手术已经从单纯减压发展到同时减压融合，并取得了令人满意的短期结果。镜下融合和灵活的麻醉方式是该项技术的最大亮点，具有手术创伤小、出血量少、住院时间短、术后疼痛少、恢复快、保存脊柱后方结构的优点，但由于术中需反复透视，外科医生及患者承受的辐射量相对较高，而且对外科医生的操作技术要求较高。③相较于传统手术，目前认为使用内镜下经椎间孔治疗腰椎退行性疾病可能是一种有效的新型治疗手段。既往对内镜下经椎间孔腰椎椎间融合的研究有一定的不足，术中使用大量的生理盐水冲洗手术部位造成隐性失血，这些隐性失血量无法计算，这一点在相关文献中并未纳入研究范围；其次，由于可开展内镜下经椎间孔腰椎椎间融合技术的医院较少，缺乏大样本及长期随访证据的支持，其长期疗效仍需进一步研究。
https://orcid.org/0000-0001-9881-6785 (靳鑫杰)；https://orcid.org/0000-0001-5360-6725 (赵斌) 

关键词: 内镜下腰椎融合术, 腰椎退行性疾病, 脊柱微创, 综述

Abstract: BACKGROUND: Lumbar degenerative disease is a common disease in middle-aged and elderly patients. Traditional lumbar spine surgery is more traumatic and takes a long time to recover after surgery. In recent years, spinal endoscopic technology has achieved great development, and endoscopic transforaminal lumbar interbody fusion, as a new treatment for lumbar degenerative diseases, is worth promoting in patients with indications for lumbar degenerative diseases because of the advantages of less trauma, shorter recovery time, less postoperative pain, and less bleeding.  
OBJECTIVE: To review the research progress of endoscopic transforaminal lumbar interbody fusion in lumbar degenerative diseases, review the occurrence, development, advantages, limitations, and development trend of endoscopic transforaminal lumbar interbody fusion.
METHODS: The first author used a computer to search PubMed, Web of Science and Wanfang databases for the literature published from 2010 to 2022. Key words were “endoscopic lumbar fusion, lumbar degenerative disease, minimally invasive spine” in Chinese and English. Duplicate, poor quality and irrelevant articles were excluded for review analysis.  
RESULTS AND CONCLUSION: (1) Degenerative diseases of the lumbar spine are the pathological basis of disc herniation, spinal stenosis, and vertebral slippage, and are the main cause of discogenic lower back pain. Endoscopic transforaminal lumbar interbody fusion is a novel technique for the treatment of degenerative diseases of the lumbar spine. (2) In recent years, endoscopic lumbar spine surgery has evolved from simple decompression to simultaneous decompression and fusion, with satisfactory short-term results. Microscopic fusion and flexible anesthesia are the greatest highlights of this technique, which has the advantages of less surgical trauma, less bleeding, shorter hospital stay, less postoperative pain, faster recovery, and preservation of the posterior spinal structures, but because of the need for repeated intraoperative fluoroscopy, the relatively high radiation exposure to the surgeon and the patient, as well as the higher requirements for the surgeon’s operating skills. (3) The use of endoscopic transvertebral foramina for the treatment of degenerative lumbar spine disease is now considered to be a potentially effective novel treatment compared to conventional surgery. In previous studies of endoscopic transforaminal lumbar interbody fusion, there were some shortcomings in the use of large amounts of saline to flush the surgical site intraoperatively causing occult blood loss, and these occult blood losses could not be calculated, which was not included in the relevant literature. Second, because fewer hospitals can perform endoscopic transforaminal lumbar interbody fusion and lack the support of large samples and long-term follow-up evidence, its long-term efficacy still needs further study.

Key words: endoscopic lumbar fusion, lumbar degenerative disease, minimally invasive, review

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