髓核置换、全椎间盘置换及腰椎后路动态稳定系统治疗腰椎退行性疾病的应用与思考

摘要

BACKGROUND:Lumbar fusion surgery as an important and effective means of treating degenerative diseases is widely used in clinical application for almost a century. However, long-term clinical evidence showed that lumbar fusion also brought some problems, such as the loss of waist flexibility, complications of donor site, fusion segment motion loss and accelerating the adjacent segment degeneration. In recent years, the theory of spinal dynamic stabilization had spread widely, and a variety of non-fusion surgery is becoming more broadly used in treatment of lumbar degenerative disease. OBJECTIVE:To review the application of non-fusion surgery in the treatment of lumbar degenerative diseases and explain application perspectives and experiences. METHODS:Databases including PubMed and CNKI were retrieved to col ect clinical application and views about non-fusion internal fixation in the treatment of lumbar degenerative diseases from 2007 to 2016. The key words were“lumbar, non-fusion, bone fusion, dynamic stabilization, adjacent segment degeneration”. RESULTS AND CONCLUSION:Thirty papers were included in the final analysis after screening by two independent researchers. We summarized the lumbar non-fusion technology, including artificial nucleus replacement, total disc replacement and posterior lumbar dynamic stabilization device. The philosophy of these new technologies is to provide stability and physiological activity, reducing the abnormal stress that leads to adjacent segment degeneration. These methods can be applied to the step of treatment of lumbar degenerative diseases and to reduce the fusion of diseased segments. Simultaneously, it is needed to strictly grasp the indications for surgery, to identify the cause of the pain caused by low back pain and lumbar spine instability, and to select the most suitable non-fusion device for individual treatment.%背景：腰椎融合作为退行性疾病治疗的重要有效手段广泛用于临床已近百年，但是长期的临床随访表明，腰椎融合也带来了一些问题，包括腰部柔韧性减退、供骨区并发症、融合节段运动丧失，以及载荷转移导致相邻节段退变加剧等。近十几年来，脊柱动态固定的理论广泛传播，多种不同的非融合手术越来越普遍地被应用于处理腰椎退行性疾病。　　目的：综述非融合手术在腰椎退行性疾病的临床应用，阐述应用方面的观点与经验。　　方法：检索中国知网和PubMed数据库，检索词分别为“腰椎、非融合、植骨融合、动态固定、相邻节段退变”和“lumbar，non-fusion，bone fusion，dynamic stabilization，adjacent segment degeneration”，检索时间：2007年至2016年，语言分别设定为中文和英文。搜集关于非融合技术应用于腰椎退行性疾病的研究进展、临床经验与观点。　　结果与结论：由2名研究员独立对文献进行筛选，最终纳入30篇文献。总结了3大类非融合技术：髓核置换、全椎间盘置换及腰椎后路动态稳定系统，这些新技术体现的理念是提供脊柱稳定性同时保留一定的灵活性，消除能导致相邻节段退变加速的异常应力。这些方法可作为腰椎退行性疾病的阶梯化治疗，减少对患病节段的融合；同时，需严格掌握其手术适应证、准确鉴别下腰痛和腰椎不稳的致痛原因、选择最适合的非融合装置进行个体化治疗。