警告：請(qǐng)?jiān)谟蠾IFI的場(chǎng)所觀看視頻,，土豪請(qǐng)隨意,。

Lateral Lumbar Interbody Fusion (LLIF)

側(cè)路腰椎椎體間融合術(shù)

Introduction (介紹）

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.

　　為緩解腰痛,，有各種各樣的腰椎椎體間融合技術(shù)。側(cè)入路脊柱手術(shù)是一種微創(chuàng)的手術(shù),，它通過(guò)身體側(cè)面的切口來(lái)顯露脊柱,。這個(gè)手術(shù)避免了其它脊柱微創(chuàng)融合技術(shù)（PLIF、TLIF,、ALIF）那樣需要分離腰部的肌肉,、切開(kāi)骨頭或?qū)⒀軤块_(kāi)。側(cè)入路脊柱外科手術(shù)可用于治療許多疾病,，包括椎間盤(pán)突出,，非對(duì)稱(chēng)性椎間盤(pán)退變（退變性脊柱側(cè)彎）、神經(jīng)卡壓,、某些腫瘤,，以及在這個(gè)動(dòng)畫(huà)片里所涉及到的因椎間盤(pán)退變引起的不穩(wěn)和疼痛。當(dāng)治療這種原因引起的腰痛和腿痛時(shí),，將大部分椎間盤(pán)去除,，用椎間融合器來(lái)維持合適的椎間盤(pán)高度，并用骨移植促時(shí)相鄰椎體的融合,，保持脊柱穩(wěn)定,。這種手術(shù)往往稱(chēng)為側(cè)方入路腰椎椎間融合術(shù)，簡(jiǎn)稱(chēng)LLIF,。

Incision and Dilation (切口和擴(kuò)張）

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.

　　在腰的側(cè)面作約2英寸的小切口,，有時(shí)在其后方另作一個(gè)小點(diǎn)的切口（大約1英寸），用于引導(dǎo)手術(shù)器械,。通常使用一種能在屏幕上顯示X線(xiàn)圖像的稱(chēng)為透視的設(shè)備來(lái)精確定位將要實(shí)施手術(shù)的脊柱部位,。從切口插入一根細(xì)的探針通過(guò)脊柱旁邊的肌肉（稱(chēng)為腰大肌）直達(dá)脊柱,。探針與神經(jīng)監(jiān)測(cè)儀相連,，有助于術(shù)者用探針尋找脊柱上正確的位置時(shí)能夠探測(cè)并避免損傷神經(jīng)。一系列直徑逐級(jí)增大的擴(kuò)張管,，也與神經(jīng)監(jiān)測(cè)儀相連,，在探針的引導(dǎo)下安全地?cái)U(kuò)大開(kāi)口。

Retractor and Instrument Set-Up （放置牽開(kāi)器及設(shè)備）

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.

　　通過(guò)擴(kuò)張管放置牽開(kāi)器,，將肌肉組織牽開(kāi)使開(kāi)口張開(kāi),，為手術(shù)創(chuàng)造空間。去除擴(kuò)張管道,，用光源設(shè)備為術(shù)野照明,。將牽開(kāi)器的頁(yè)片張開(kāi)，把周?chē)M織分開(kāi),。此時(shí),，手術(shù)顯露就完成了,。在牽開(kāi)器邊緣放置內(nèi)鏡或顯微鏡，在顯示屏上顯示近距離的圖象,，用于引導(dǎo)手術(shù),。

Disc Excision and Implant Placement （切除椎間盤(pán)，安裝內(nèi)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.

　　用手術(shù)器械將退變椎間盤(pán)的大部分切除,。在相鄰椎體間,，植入用鈦、碳纖維材料間融器或高分子材料制成的結(jié)構(gòu)性支撐籠（椎間融合器）,，維持椎體間隙高度,。椎間融合器能去除受壓神經(jīng)根的壓力，保留合適的椎間隙高度,，為脊柱提供穩(wěn)定,，支撐正常的負(fù)荷。椎間融合器內(nèi)經(jīng)常填充來(lái)自骨庫(kù)的加工骨（同種異體移植）或骨移植材料（脫鈣骨,、多孔陶瓷或骨形態(tài)發(fā)生蛋白）,，以促進(jìn)骨再生，將椎體永久性地融合在一起,。

Summary （總結(jié)）

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,，關(guān)閉切口并包扎，完成手術(shù),。側(cè)入路腰椎椎間融合術(shù)對(duì)周?chē)M織損傷很小,，有利于很快恢復(fù)正常活動(dòng),。與其它融合技術(shù)相比,，手術(shù)快、麻醉時(shí)間短,，失血少，疼痛輕,。有些病人在手術(shù)當(dāng)天就能出院,，大部分在術(shù)后3月能恢復(fù)正常活動(dòng),。

（高晨珉    轉(zhuǎn)）