动画：后路腰椎椎体间融合术（PLIF）

动画：后路腰椎椎体间融合术（PLIF）

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A posterior lumbar interbody fusion, called a PLIF, is a surgery designed to stop the motion at the targeted segment of the spine.

后路腰椎椎体间融合术，简称PLIF。该手术设计用于阻止脊柱目标节段的活动。

A PLIF is done in the lumbar, or lower, spine. Most commonly it is performed on the L4-L5 or L5-S1 segment at the bottom of the lumbar spine.

PLIF手术应用于腰椎或下方的脊椎。通常用于腰4/5或腰5/骶1（腰椎下方）节段。

This surgery may be done to treat lumbar degenerative disc

disease, in which a degenerated disc becomes painful. It may also be done for a lumbar spondylolisthesis, in which one vertebra slips forward over the vertebra below it.

该术式被用于治疗腰椎椎间盘退变性疾病，此时，退变的椎间盘引起疼痛。PLIF还可用于腰椎滑脱，即一个椎体在下位椎体的上方向前滑移。

A PLIF starts with a three to six-inch long incision in the midline of the back.

PLIF手术首先在背部正中线作一个3～6英寸长的切口。

Next, the lower back muscles, called erector spinae, are stripped off the lamina on both sides and at multiple levels.

然后，将腰部的肌肉（称为竖脊肌）在多个节段从两侧的椎板上剥离下来。

The lamina is removed, which allows visualization of the nerve roots.

去除椎板，就可以看到神经根。

The facet joints, which are directly over the nerve root, may then be trimmed to give the nerve roots more room.

修剪神经根正后方的关节突关节，使神经根周围有足够空间。

The nerve roots are then retracted to one side and the disc space is cleaned of the disc material.

然后将神经根牵向一侧，将椎间隙的椎间盘组织清除。

Some type of implant, called a cage, is then inserted into the disc space. The cage helps restore more of the normal spacing in

between the vertebrae, alleviating pressure on the nerve roots.

被称为骨笼的一类内植物，被植入到椎间隙。骨笼有助于保留椎体间正常的间隙，缓解神经根的压迫。

Bone graft is placed in the cage and along the sides of the spine.

骨移植物被置入骨笼以及脊柱的侧面。

There are many bone graft options. If the patient's own bone graft is used, bone morsels are harvested from the patient's iliac crest, along the back of the hip.

骨移植物有许多选择。如果使用病人自体骨，可以沿着髋骨的后方，从病人的髂嵴上取碎骨片。

This is an additional surgical procedure that is done at the same time as the fusion surgery.

在融合手术的同时，取骨是额外的手术操作。

Bone that has been removed from a laminectomy may also be used, or synthetic bone graft options may be used.

从椎板切除术中切下的骨也可用于植骨。或者使用合成的骨移植材料。

The surgeon may implant a series of screws and rods to the back of the spine for additional support.

外科医生可能会在脊柱的后方植入一系列的螺钉和棒以获得额外的支撑。

A PLIF fusion may be supplemented by a simultaneous posterolateral spine fusion surgery.

PLIF融合术可能同时作后外侧脊柱融合手术作为补充。

In addition to open surgery, a PLIF may sometimes be done through a tube in a minimally invasive approach.

在开放手术的基础上，有时会用通道系统在微创入路作PLIF手术。

（胡佰文译）

20160712:骨科实习医师考试时间（35）

A2型题每一道考题是以一个小案例出现的，其下面都有 A、B、C、D、E五个备选答案。请从中选择一个最佳答案。

1.男，56岁，右膝关节疼痛半年，加重5天，尤以上楼梯加剧，X线片显示膝关节退行性改变，诊断为髌骨软骨软化症，非手术治疗首先应制动膝关节

A.1~2周

B.3~4周

C.5~6周

D.无需制动

E.制动2个月

2.男，30岁，左膝关节疼痛5个月逐渐加重，上、下楼梯困难，查体：左髌骨下缘局限性压痛，髌骨研磨试验(+)，股四头肌萎缩。X 线片未见异常，核素扫描见髌骨局限性核素浓聚，其诊断是

A.半月板损伤