轴向椎体间融合术微创治疗腰骶椎失稳症

目的 评价轴向椎体间融合术(AxiaLIF)微创手术治疗L5/S1失稳症的临床有效性和安全性. 方法 采用尾骨尖旁2 cm切口,在G臂X线透视下,经骶椎前方建立工作通道,骨性通道入口在S1～2之间,用特殊工具经轴向的工作通道切除椎间盘、植骨,最后拧入长度合适的轴向固定螺栓.治疗12例L5/S1失稳症,观察手术时间、术中出血量、围手术期并发症以及随访观察椎间融合情况,并采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价手术前后患者症状改善情况. 结果 手术时间30～70min,术中出血50～90 ml,无并发症发生.所有患者于术后第2天戴腰围活动.随访时间3～9个月,VAS和ODI分别由术前6.66±0.89和61.18±7.93降至术后3个月2.08±0.79和21.51±3.63,差异有统计学意义.术后融合情况:1例于术后6个月完全融合,10例部分融合,1例尚未见融合. 结论 轴向椎体间融合术手术创伤小,并发症少,术后恢复快,为L5/S1节段提供一个安全而微创的椎体间融合方式.

Clinical experience of AxiaLIF for the minimally invasive treatment of L5/S1 instability RONG Li-min,

Objective To evaluate effects and safety of axial lumbar interbody fusion (AxiaLIF) for the minimally invasive management of L5/S1 instability. Methods A 2 cm incision on paracoccygeal notch was made. With the guidance of G arm X ray, Guide Pin Introducer was inserted into pre-sacral space to establish working channel. After Guide pin introducer engaged at S1 and S2 joint part, remove disc and endplate with radial cutter and grasp disc with wire brush which were specially designed for the procedure, and then bone graft. Finally Axial Rod was implanted and the vertebral interspace was distracted. 12 cases of patients with L5/S1 in-stability were managed by means of AxiaLIF surgery. The operating time, blood loss, perioperative complication and fusion rate were observed and followed up. The Visual Analog Scale (VAS) and Oswestry disability index (ODI) were used to evaluate patients' situation pre- and post-operatively. Results The operating time was 30-70 min, blood loss 50-90 all. All the patients ambulated with corset 2 days postoperatively without compli-cation. The follow-up time were 3-9 months. The VAS and ODI were decreased from 6.66 ± 0.89/61.18 ± 7.93 preoperatively to 2.08 ± 0.79/21.51 ± 3.63 on the 3 postoperative months with significant difference. There was 1 ease got complete bony fusion, 10 cases partial fusion and 1 no evidence of fusion during the follow up. Conclusion AxiaLIF is a truly minimally invasive percutaneous technique, providing an alternative route of access to L5/S1 infusion with minimal risk and quicker recovery.