中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
8期
834-839
,共6页
曾忠友%严卫锋%陈国军%汤永华%吴鹏%宋永兴%金才益%张建乔%王斌%唐宏超
曾忠友%嚴衛鋒%陳國軍%湯永華%吳鵬%宋永興%金纔益%張建喬%王斌%唐宏超
증충우%엄위봉%진국군%탕영화%오붕%송영흥%금재익%장건교%왕빈%당굉초
腰椎%内固定器%脊柱融合术
腰椎%內固定器%脊柱融閤術
요추%내고정기%척주융합술
Lumbar vertebrae%Internal fixators%Spinal fusion
目的 探讨单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定治疗下腰椎病变的可行性和疗效.方法 男8例,女22例;年龄39～68岁,平均53.7岁.腰椎间盘退变11例,腰椎间盘突出症术后原位复发4例,巨大型腰椎间盘突出5例,腰椎间盘突出伴椎管狭窄4例,腰椎退行性滑脱(Ⅰ度)6例.L3,42例、L4,5 20例、L5S1 8例.采用单侧显露、减压、同侧椎弓根螺钉固定,同时在自行设计的瞄准器引导下经皮对侧进行椎板关节突螺钉固定并椎间融合器植骨方法治疗.观察手术时间、术中出血量和术后引流量.通过影像学评价椎板关节突螺钉位置.采用日本骨科学会(Japanese Orthopaedic Association,JOA)下腰痛评分系统(29分法)评价疗效.结果 手术时间75～110 min,平均89 min;术中出血量为180～500ml,平均285 ml,均未输血.椎板关节突螺钉位置Ⅰ型24例,Ⅱ型6例.术后2例病例出现终板切割,融合器部分陷入终板及椎体内.随访时间12～36个月,平均22.5个月.除1例不能明确外,其余均获得骨性融合,融合率为96.7%.随访过程中椎弓根螺钉与椎板关节突螺钉未出现松动、移位、断裂,椎间融合器亦无移位现象.JOA评分由术前的10～16分(平均13.0分)提高到22～27分(平均25.2分),改善率为61.7%～90.5%,平均72.5%.结论 单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定具有操作简单、创伤小、稳定性好、融合率高和并发症少等优点,是部分下腰椎病变固定融合的较好选择.
目的 探討單側椎弓根螺釘聯閤對側經皮椎闆關節突螺釘固定治療下腰椎病變的可行性和療效.方法 男8例,女22例;年齡39～68歲,平均53.7歲.腰椎間盤退變11例,腰椎間盤突齣癥術後原位複髮4例,巨大型腰椎間盤突齣5例,腰椎間盤突齣伴椎管狹窄4例,腰椎退行性滑脫(Ⅰ度)6例.L3,42例、L4,5 20例、L5S1 8例.採用單側顯露、減壓、同側椎弓根螺釘固定,同時在自行設計的瞄準器引導下經皮對側進行椎闆關節突螺釘固定併椎間融閤器植骨方法治療.觀察手術時間、術中齣血量和術後引流量.通過影像學評價椎闆關節突螺釘位置.採用日本骨科學會(Japanese Orthopaedic Association,JOA)下腰痛評分繫統(29分法)評價療效.結果 手術時間75～110 min,平均89 min;術中齣血量為180～500ml,平均285 ml,均未輸血.椎闆關節突螺釘位置Ⅰ型24例,Ⅱ型6例.術後2例病例齣現終闆切割,融閤器部分陷入終闆及椎體內.隨訪時間12～36箇月,平均22.5箇月.除1例不能明確外,其餘均穫得骨性融閤,融閤率為96.7%.隨訪過程中椎弓根螺釘與椎闆關節突螺釘未齣現鬆動、移位、斷裂,椎間融閤器亦無移位現象.JOA評分由術前的10～16分(平均13.0分)提高到22～27分(平均25.2分),改善率為61.7%～90.5%,平均72.5%.結論 單側椎弓根螺釘聯閤對側經皮椎闆關節突螺釘固定具有操作簡單、創傷小、穩定性好、融閤率高和併髮癥少等優點,是部分下腰椎病變固定融閤的較好選擇.
목적 탐토단측추궁근라정연합대측경피추판관절돌라정고정치료하요추병변적가행성화료효.방법 남8례,녀22례;년령39～68세,평균53.7세.요추간반퇴변11례,요추간반돌출증술후원위복발4례,거대형요추간반돌출5례,요추간반돌출반추관협착4례,요추퇴행성활탈(Ⅰ도)6례.L3,42례、L4,5 20례、L5S1 8례.채용단측현로、감압、동측추궁근라정고정,동시재자행설계적묘준기인도하경피대측진행추판관절돌라정고정병추간융합기식골방법치료.관찰수술시간、술중출혈량화술후인류량.통과영상학평개추판관절돌라정위치.채용일본골과학회(Japanese Orthopaedic Association,JOA)하요통평분계통(29분법)평개료효.결과 수술시간75～110 min,평균89 min;술중출혈량위180～500ml,평균285 ml,균미수혈.추판관절돌라정위치Ⅰ형24례,Ⅱ형6례.술후2례병례출현종판절할,융합기부분함입종판급추체내.수방시간12～36개월,평균22.5개월.제1례불능명학외,기여균획득골성융합,융합솔위96.7%.수방과정중추궁근라정여추판관절돌라정미출현송동、이위、단렬,추간융합기역무이위현상.JOA평분유술전적10～16분(평균13.0분)제고도22～27분(평균25.2분),개선솔위61.7%～90.5%,평균72.5%.결론 단측추궁근라정연합대측경피추판관절돌라정고정구유조작간단、창상소、은정성호、융합솔고화병발증소등우점,시부분하요추병변고정융합적교호선택.
Objective To investigate the feasibility and efficiency of unilateral pedicle screw combined with contralateral translaminar facet screw fixation by percutaneous and interbody fusion to treat low lumbar vertebra diseases. Methods Thirty patients with low lumbar vertebra diseases were entered into the study, including 8 males and 22 females with an average age of 53.7 years. All patients underwent discectomy, spinal canal decompression, cage implantation and lumbar fixation by unilateral pedicle screw combined with contralateral translaminar facet screw under gunsight guiding by percutaneous. Clinical outcomes were assed by JOA questionnaires before and after operation. Operative time, blood loss, and postoperative draiming were recorded. Radiological examination was obtained to assess position of translaminar facet screw.Results Mean operation time was 89 min with a blood loss of 285 ml. Position of translaminar facet screw grade Ⅰ were 24 cases, and grade 11 were 6. Mean follow-up was 22.5 months. 29 cases got bony fusion, and the fusion rate was 96.7%. There were no instability and evidence instrument failure during follow-up. The JOA grades improved from 13.0 preoperation to 25.2 at final follow-up, with the excellent and good rate of 72.5 %. Conclusion Unilateral pedicle screw combined with contralateral translaminar facet screw fixation by percutaneous and interbody fusion provide simple procedure, little trauma, forceful fixation, high fusion rate, and less complication, etc. Therefore, the surgical maneuver is a good choice for partial low lumbar vertebra diseases.
