摘要目的 总结斜外侧腰椎椎间融合术（OLIF）治疗成人脊柱畸形的研究进展。方法 以“斜外侧腰椎椎间融合术” “成人脊柱畸形” “脊柱微创手术”和“oblique lumbar interbody fusion”“adult spine deformity”“minimally invasive spine surgery”为中、英文关键词,在中国知网、万方数据、维普数据库及PubMed检索2022年12月之前发表的有关OLIF的解剖学优势、治疗成人脊柱畸形的临床效果,以及解剖学相关并发症的文献共98篇,剔除内容不符合、无法获取原文、重复性研究或存在设计缺陷的研究,最终纳入38篇相关文献进行归纳总结。结果 采用OLIF治疗成人脊柱畸形,术中通过大血管鞘和腰大肌之间的天然间隙放置工作通道,从椎间隙斜前方直达手术节段完成间接减压,避免了对后方肌肉韧带复合体的破坏,减少手术创伤及出血感染风险。该术式可在一定程度上矫正患者在冠状位、矢状位的脊柱畸形,但矫形能力相对有限;可通过置入带角度的融合器及合理规划融合器置入区域矫正腰椎前凸角,有效恢复躯干平衡。采用OLIF治疗成人脊柱畸形时需注意,由于其特殊的手术入路,操作时会对腰交感链及腰丛神经、腰椎节段动脉及髂血管、终板等周围组织结构造成损伤。结论 OLIF是微创治疗成人脊柱畸形的有效手段之一,可有效改善神经症状及恢复躯干平衡,具有减少手术创伤、降低术中出血风险及围术期并发症风险等优势。由于其对脊柱畸形的矫形能力相对有限,为避免OLIF解剖学相关的手术并发症的风险,应严格把握手术适应证,术前应完善CT、MRI及骨密度等相关检查。
【Abstract】 Objective Research progress on oblique lumbar interbody fusion(OLIF) for adult spine deformity(ASD) treatment was explored. Methods Articles about anatomical advantages and the complications of OLIF in patients with ASD were searched in CNKI, WanFang, WeiPu, and PubMed databases before December 2022. "斜外侧腰椎椎间融合术" "成人脊柱畸形" "脊柱微创手术" "oblique lumbar interbody fusion" "adult spine deformity" and "minimally invasive spine surgery" were used as key words, and the clinical effects and capability of OLIF for correction and balance restoration were explored. A total of 98 articles were searched, and 38 were finally included after articles that did not conform to the content, no available full text, were repeated studies, or had design defects were excluded. Results The procedure corridor of OLIF is between the aorta and psoas. OLIF achieves indirect neural decompression, preventing the destruction of the posterior muscular ligament complex and lowering surgical trauma, risk of bleeding, and infection. For patients with ASD, OLIF can provide partial correction to coronal and sagittal deformity, but it has limitation to correction. By inserting a lordotic cage and planning the reasonable cage area, OLIF can effectively correct lumbar lordosis and restore the trunk balance, producing a good clinical effect. When OLIF is used to treat adult spinal malformations, it damages the lumbar sympathetic chain, lumbar plexus, lumbar segmental arteries, iliac vessels, and endplates during operation owing to its special surgical approach. Conclusion OLIF is one of the effective and minimally invasive treatments for ASD and can effectively alleviate neurological deficits, restore trunk balance, reduce surgical trauma, and lower intraoperative bleeding, perioperative complications, and off-bed time. Surgical indications should be controlled because of its relatively limited capability for correction and balance restoration. Bone density, CT, MRI, and other related examinations should be improved before surgery. During an operation, surgeons should prevent damage to the peripheral vascular system and nerves to reduce surgical complications.
伍宇轩, 包贝西, 唐家广. 斜外侧腰椎椎间融合术治疗成人脊柱畸形的研究进展[J]. 中华解剖与临床杂志, 2024, 29(1): 64-68.
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2024, Vol. 29 
