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Lateral Lumbar Interbody Fusion (LLIF) 侧路腰椎椎体间融合术 Introduction (介绍） A variety of techniques exist for fusing lumbar spine vertebrae to help alleviate back pain. Lateral access spine surgery is a minimally invasive surgery that accesses the spine from incisions on the side of the body. This procedure avoids separating the low back muscles, cutting bone, or moving aside blood vessels as required for other minimally invasive spine fusion procedures (PLIF, TLIF, ALIF). Lateral access spine surgery can treat a variety of conditions including herniations, asymmetric disc degeneration (degenerative scoliosis), nerve impingement, certain tumors, and as discussed in this animation, instability and pain resulting from disc degeneration. When treating this source of back and leg pain, most of the disc is removed, a spacer is used to restore proper disc height, and bone grafts are added to fuse the adjacent vertebrae, restoring stability. This procedure is commonly called the Lateral Lumbar Interbody Fusion, or LLIF. 为缓解腰痛，有各种各样的腰椎椎体间融合技术。侧入路脊柱手术是一种微创的手术，它通过身体侧面的切口来显露脊柱。这个手术避免了其它脊柱微创融合技术（PLIF、TLIF、ALIF）那样需要分离腰部的肌肉、切开骨头或将血管牵开。侧入路脊柱外科手术可用于治疗许多疾病，包括椎间盘突出，非对称性椎间盘退变（退变性脊柱侧弯）、神经卡压、某些肿瘤，以及在这个动画片里所涉及到的因椎间盘退变引起的不稳和疼痛。当治疗这种原因引起的腰痛和腿痛时，将大部分椎间盘去除，用椎间融合器来维持合适的椎间盘高度，并用骨移植促时相邻椎体的融合，保持脊柱稳定。这种手术往往称为侧方入路腰椎椎间融合术，简称LLIF。 Incision and Dilation (切口和扩张） A small incision, approximately two inches in length, is made directly at the side of the waist and occasionally a smaller incision (approx. one inch) is made behind it to help guide surgical instruments. A device that projects live X-ray images onto a screen, called a fluoroscope, is typically used to pinpoint the exact position on the spine where the surgery will be performed. A thin probe is inserted through the incision and directed toward the spine through a muscle lying next to the spine, called the psoas muscle. The probe is attached to nerve monitoring equipment, allowing the surgeon to detect and avoid nerves as the probe travels to the correct position on the spine. A series of dilators with increasing diameters, which are also connected to nerve monitoring equipment, are guided over the probe to safely enlarge the opening. 在腰的侧面作约2英寸的小切口，有时在其后方另作一个小点的切口（大约1英寸），用于引导手术器械。通常使用一种能在屏幕上显示X线图像的称为透视的设备来精确定位将要实施手术的脊柱部位。从切口插入一根细的探针通过脊柱旁边的肌肉（称为腰大肌）直达脊柱。探针与神经监测仪相连，有助于术者用探针寻找脊柱上正确的位置时能够探测并避免损伤神经。一系列直径逐级增大的扩张管，也与神经监测仪相连，在探针的引导下安全地扩大开口。 Retractor and Instrument Set-Up （放置牵开器及设备） A retractor device is placed over the dilators to hold back the muscle and expand the opening to allow room for the surgery. The dilators are removed and a lighting component is attached to illuminate the surgical field. The retractor blades are opened to hold the tissues out of the way. The surgical exposure is now complete. An endoscope or microscope is then added to the edge of the retractor to provide close-up imagery on a screen to help guide the procedure. 通过扩张管放置牵开器，将肌肉组织牵开使开口张开，为手术创造空间。去除扩张管道，用光源设备为术野照明。将牵开器的页片张开，把周围组织分开。此时，手术显露就完成了。在牵开器边缘放置内镜或显微镜，在显示屏上显示近距离的图象，用于引导手术。 Disc Excision and Implant Placement （切除椎间盘，安装内植物） Surgical instruments are used to remove a large portion of the degenerating vertebral disc. An interbody spacer, which is an implant comprised of a titanium, carbon-fiber, or polymer structural support cage that spans the width of a vertebral body, is positioned between the adjacent vertebrae. The spacer removes pressure from nerve roots which may have been pinched, restores the proper disc height, and provides stability to the spine for supporting normal loads. The cage is often packed with processed bone from a bone bank (allograft), or a bone graft substitute (demineralized bone, ceramic extender, or bone morphogenetic protein), which encourages regeneration of bone that will permanently fuse the vertebrae. 用手术器械将退变椎间盘的大部分切除。在相邻椎体间，植入用钛、碳纤维材料间融器或高分子材料制成的结构性支撑笼（椎间融合器），维持椎体间隙高度。椎间融合器能去除受压神经根的压力，保留合适的椎间隙高度，为脊柱提供稳定，支撑正常的负荷。椎间融合器内经常填充来自骨库的加工骨（同种异体移植）或骨移植材料（脱钙骨、多孔陶瓷或骨形态发生蛋白），以促进骨再生，将椎体永久性地融合在一起。 Summary （总结） The instruments are withdrawn and the incisions are closed and dressed to complete the procedure. The LLIF procedure is performed with minimal injury to surrounding tissues, which may allow a faster return to normal activity. The surgery may be performed more quickly with less anesthesia time, blood loss, and pain compared to other fusion techniques. Some patients are released from the hospital the day following their surgery, and most can expect to return to normal activities in about 3 months. 撤除器械，关闭切口并包扎，完成手术。侧入路腰椎椎间融合术对周围组织损伤很小，有利于很快恢复正常活动。与其它融合技术相比，手术快、麻醉时间短，失血少，疼痛轻。有些病人在手术当天就能出院，大部分在术后3月能恢复正常活动。 （高晨珉 转） |
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