无 C 型臂同时 OLIF51 和经皮椎弓根螺钉固定在单个侧位
Summary
在导航引导下，在横向位置进行 L5-S1 水平 （OLIF51） 的无 C 臂倾斜腰椎间融合术和同时的椎弓根螺钉固定。这种技术不会使外科医生或手术人员暴露于辐射危害。
Abstract
斜腰椎体间融合术 （OLIF） 是一种用于间接减压腰椎管狭窄的成熟技术。然而，由于解剖学结构的原因，L5-S1级别的OLIF（OLIF51）在技术上是困难的。我们提出了一种新颖的OLIF51同步技术，经皮椎弓根螺钉固定，无需透视。将患者置于右侧卧位。将经皮参考销插入右骶髂关节。执行O型臂扫描，并将3D重建图像传输到脊柱导航系统。在沿着骨盆的导航引导下做一个4厘米的斜皮肤切口。腹内/外和横腹肌沿着肌纤维分开，保护髂下腹神经和髂腹股沟神经。使用腹膜后入路，可识别左髂总血管。带有照明的特殊肌肉牵开器用于暴露L5-S1椎间盘。使用导航仪器准备光盘后，光盘空间会因导航试验而分散注意力。然后将自生骨和脱矿质骨材料插入笼孔中。OLIF51笼子在木槌的帮助下插入光盘空间。同时，经皮椎弓根螺钉由另一位外科医生插入，而不改变患者的侧卧位。
总之，在导航引导下，在横向位置进行无C臂OLIF51和同时经皮椎弓根螺钉固定。这种新技术减少了手术时间和辐射危害。
Introduction
脊柱病被认为是应力性骨折1 ，发生在约5%的年轻成年人群中2。最常见的发生水平是在L5水平，因为在L5-S1区域施加了独特的剪切力。脊柱病和脊柱滑脱的主要症状是腰痛、腿部疼痛和麻木。如果保守治疗无效，建议手术治疗3.经椎间孔腰椎间融合术 （TLIF） 是一种有效且成熟的技术4，但该手术的非骨折发生率在 L5-S1级别 5 时相对较高。此外，与斜腰椎椎体间融合术 （OLIF） 或前腰椎体间融合术 （ALIF） 相比，TLIF 很难产生足够的脊柱前凸6。
间接减压（如ALIF或OLIF）是目前治疗腰椎管狭窄的常用方法7。然而，传统的ALIF技术会导致大量的肌肉损伤。L5-S1水平（OLIF51）的斜侧向体间融合于2017年首次报道8。通常需要后部器械增强以确保固体融合，但传统的OLIF技术使用C型臂，并且患者位置从侧向改为俯卧。为了克服这些问题，我们在这里报告了一种在单个横向位置上无C臂同时OLIF51和经皮椎弓根螺钉（PPS）的新技术。
我们介绍一名75岁妇女患有有症状的L5脊柱滑脱（2级）的病例。
Protocol
本研究获得冈山玫瑰医院伦理委员会（No. 201-3）的批准。 1. 患者检查 历史采集 通过采集病史来评估疑似椎间盘突出或狭窄的患者。通常，患者有前驱腰痛病史。患者可能将其症状与创伤发作相关联。 要求患者描述放射性腿部疼痛、其位置以及加重和缓解活动。 体检 为了确定受累神经的水平，寻找腿部运动无力或感?…
Representative Results
14例（平均年龄：71.5岁）使用这种新技术进行治疗。他们将他们与L5-S1 TLIF的40例（平均年龄：74.0岁）进行比较。两组均测定L5-S1前凸角和椎间盘高度。OLIF51组获得比TLIF 51组更好的L5-S1前凸（图15）。 图 15：放射?…
Discussion
最近，用于椎间融合的侧腰椎方法因其微创性而越来越受欢迎9。在这些方法中，直接侧向腰大肌分裂方法有几个缺点，如腰神经丛损伤和腰大肌无力10。为了减少这些并发症，戴维斯等人在2014年引入了预置骨灰质或OLIF11。然而，由于其解剖学特征，很难在L5-S1椎间盘上操作。2017年，设计了一种新技术，以横向位置（OLIF51）接近L5-S1椎间盘，使?…
Declarações
The authors have nothing to disclose.
Acknowledgements
这项研究得到了冈山脊柱小组的支持。
Materials
| Adjustable hinged operating carbon table | Mizuho OSI | 6988A-PV-ACP | OSI Axis Jackson table |
| CD Horizon Solera Voyager | Medtronic | 6.4317E+11 | Percutaneous pedicle screw system |
| Navigated Cobb elevator | Medtronic | NAV2066 | |
| Navigated combo tool | Medtronic | NAV2068 | |
| Navigated curette | Medtronic | NAV2069 | |
| Navigated high speed bur | Medtronic | EM200N | Stelth |
| Navigated passive pointer | Medtronic | 960-559 | |
| Navigated pedicle probe | Medtronic | 9734680 | |
| Navigated shaver | Medtronic | NAV2071 | |
| NIM Eclipse system | Medtronic | ECLC | Neuromonitouring |
| O-arm | Medtronic | 224ABBZX00042000 | Intraoperative CT |
| Radiolucent open spine cramp | Medtronic | 9731780 | |
| Self-retaining retractor | Medtronic | 29B2X10008MDT151 | |
| Sovereign Spinal System | Medtronic | 6.4317E+11 | OLIF51 cage |
| Spine small passive frame | Medtronic | 9730605 | |
| Stealth station navigation system Spine 7R | Medtronic | 9733990 | Navigation |
| U-NavLock Gray | Medtronic | 9734590 | |
| U-NavLock Green | Medtronic | 9734734 | |
| U-NavLock Orange | Medtronic | 9734683 | |
| U-NavLock Violet | Medtronic | 9734682 |
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Citar este artigo
Tanaka, M., Ruparel, S., Oda, Y., Fujiwara, Y., Shama, S., Uotani, K., Arataki, S., Yamauchi, T., Sake, N. C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position. J. Vis. Exp. (187), e63572, doi:10.3791/63572 (2022).