腹腔镜下腰椎人工椎间盘置换术的初步临床应用

Preliminary clinic application of artificial lumbar disc replacement under laparoscope

中文关键词:  人工椎间盘置换  腰椎  腹腔镜

英文关键词:Artificial disc replacement  Lumbar  Laparoscope

中文摘要:

  【摘要】 目的：探讨腹腔镜下腰椎人工椎间盘置换术的临床应用可行性。方法：2009年3月~2010年5月在腹腔镜下完成Active-L腰椎人工椎间盘置换术12例，男性8例，女性4例；年龄42~56岁，平均46.6岁；椎间盘源性腰痛9例，腰椎间盘突出症3例；手术椎间隙L4/5 7例，L5/S1 5例。术前均经6个月以上非手术治疗无效或加重；术前均常规行下腰椎前方血管三维CT血管造影（three dimensional computed tomographic angiogra?鄄phy，3D-CTA），术后3d、1个月、3个月、1年复查腰椎正侧位、动力位X线片。结果：所有患者均全程在腹腔镜下完成手术，手术时间90～180min，平均136min；术中失血约80～360ml，平均120ml。术中无大血管、输尿管、腹腔脏器等损伤。术后患者症状均明显缓解。随访5～64周，平均33周，除1例假体位置不良外，其余无假体松动、移位及下沉发生；5例随访超过1年患者术后1年时手术节段活动范围（ROM） 7°～9°，平均8.2°。结论：在具备腹腔镜技术与开放腰椎人工椎间盘置换技术的基础上， 在腹腔镜下可以完成L4/5和L5/S1人工椎间盘置换术。

英文摘要:

  【Abstract】 Objective：To study the feasibility of clinic application of artificial lumbar disc replacement under laparoscope.Method：12 cases who underwent artificial lumbar disc replacement under laparoscope from March 2009 to May 2010 were reviewed retrospectively，including 8 males and 4 females with an average age of 46.6 years（range，42 to 56 years）.9 cases presented with discogenic low back pain and 3 cases with lumbar disc herniation.L4/5 segment was involved in 7 cases and L5/S1 in 5 cases.All patients underwent conservative treatment for at least 6 months，but did not respond.All patients underwent three-dimensional computed tomographic angiography（3D-CTA） for blood vessels in front of the lower lumbar prior to operation.The anteroposterior， lateral and dynamic X-ray was performed 3 days，1 month，3 months and 1 year after operation respectively.Result：All laparoscopic operations were completed successfully.The mean operation time was 136min（range， 90-180min） and the mean intraoperative blood loss was 120ml（range，80-360ml）.There was no injury to the major vessels，ureteral and abdominal viscera.All patients had low back pain relieved.The mean follow-up was 33 weeks（range，5-64 weeks）.No instrument failure except one prosthesis malposition.5 cases with follow-up of more than 1 year had the mean range of motion（ROM） of 8.2°（range，7°-9°）.Conclusion：It is feasible to perform artificial lumbar disc replacement（L4/5 and L5/S1） under laparoscope based on the techniques of laparoscopy and open surgery.