单侧椎弓根螺钉固定联合椎间融合术在腰椎退行性疾病中的应用分析(1)
[摘要] 目的 探讨单侧椎弓根螺钉固定联合椎体间植骨融合术在腰椎退行性疾病中的应用价值。方法 整群选取郑州市骨科医院自2011年6月—2013年6月收治的52例腰椎退行性病变患者为研究对象，所有患者均为单节段病变并接受旁正中入路单侧椎弓根螺钉固定联合椎体间植骨融合术治疗，记录所有患者手术时间、术中出血量、术后并发症以及术前、术后3个月和末次随访时腰部和下肢疼痛的视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果 所有患者均顺利接受手术治疗，平均手术时间为(106±23.5)min，平均术中出血量为(164.3±32.7)mL；术中及术后未发生神经根损伤、深部组织感染和硬膜囊撕裂等并发症。所有患者术后均接受随访，平均随访时间为(22.4±3.6)个月。术后所有患者VAS和ODI较术前相比均明显降低，3组间差异均有统计学意义(P<0.05)；术后3个月与末次随访的VAS和ODI差异无统计学意义(P>0.05)。结论 单侧椎弓根螺钉固定联合椎体间植骨融合术治疗腰椎退行性疾病具有微创优势，值得在临床中推广应用。
[关键词] 腰椎退行性疾病；单侧椎弓根螺钉固定；椎体间植骨融合术；效果
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2015)11(c)-0078-03
[Abstract] Objective To discuss the value of unilateral pedicle screw fixation combined with intervertebral bone graft fusion in patients with lumbar degenerative disease. Methods 52 patients with lumbar degenerative disease admitted at the orthopaedic hospital of zhengzhou city from 2011 June to 2013 June were selected as research object， and all patients were with single segmental lesions and underwent unilateral pedicle screw fixation through paramedian approach combined with intervertebral bone graft fusion. The operation duration， intraoperative blood loss， postoperative complications， postoperative， 3 months postoperative， and last follow-up VAS and ODI for pain in the waist and lower extremities of all the patients were recorded. Results All patients well accepted surgical treatment， the average operation duration was(106±23.5)min and the mean bleeding volume was(164.3±32.7)mL. No serious complications including nerve root injury， deep tissue infections and epidural capsule tearing occurred before and after operation. All the patients accepted follow-up and the average follow-up time was(22.4±3.6) months. The VAS and ODI of all patients decreased after operation and there were statistical significant differences in all the three groups(all P<0.05).There were no statistical significant differences between 3 months postoperative VAS and ODI and last follow-up VAS and ODI in all the three groups(P>0.05). Conclusion Unilateral pedicle screw fixation combined with intervertebral bone graft fusion in the treatment of patients with lumbar degenerative disease is worth popularization and application because it is minimally invasive.
[Key words] Lumbar degenerative disease； Unilateral pedicle screw fixation； Intervertebral bone graft fusion； Effect
腰椎退行性病变是脊柱外科常见疾病之一，临床类型众多，包括腰椎间盘突出、腰椎滑脱、腰椎不稳定、腰椎管狭窄等，给患者的生活带来了极大的痛苦和不便[1]。大约80%的腰椎退行性疾病患者经保守治疗即可获得较好的效果，但是仍有部分患者保守治疗难以缓解，不得不进行手术治疗[2]。经典的手术方式是双侧椎弓根螺钉联合腰椎融合术，此术式虽可获得坚强的内固定，但是由于邻近节段应力过于集中容易引起相邻节段的退行性变。近年来单侧椎弓根联合椎体间植骨融合术逐渐得到了应用，并可以获得与双侧椎弓根螺钉相同的效果。该院自2011年6月以来使用单侧椎弓根螺钉固定联合椎体间植骨融合术治疗了多例腰椎退行性疾病患者取得了良好的效果，现报道如下。 (周若南 杨树东 孙士强)
[关键词] 腰椎退行性疾病；单侧椎弓根螺钉固定；椎体间植骨融合术；效果
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2015)11(c)-0078-03
[Abstract] Objective To discuss the value of unilateral pedicle screw fixation combined with intervertebral bone graft fusion in patients with lumbar degenerative disease. Methods 52 patients with lumbar degenerative disease admitted at the orthopaedic hospital of zhengzhou city from 2011 June to 2013 June were selected as research object， and all patients were with single segmental lesions and underwent unilateral pedicle screw fixation through paramedian approach combined with intervertebral bone graft fusion. The operation duration， intraoperative blood loss， postoperative complications， postoperative， 3 months postoperative， and last follow-up VAS and ODI for pain in the waist and lower extremities of all the patients were recorded. Results All patients well accepted surgical treatment， the average operation duration was(106±23.5)min and the mean bleeding volume was(164.3±32.7)mL. No serious complications including nerve root injury， deep tissue infections and epidural capsule tearing occurred before and after operation. All the patients accepted follow-up and the average follow-up time was(22.4±3.6) months. The VAS and ODI of all patients decreased after operation and there were statistical significant differences in all the three groups(all P<0.05).There were no statistical significant differences between 3 months postoperative VAS and ODI and last follow-up VAS and ODI in all the three groups(P>0.05). Conclusion Unilateral pedicle screw fixation combined with intervertebral bone graft fusion in the treatment of patients with lumbar degenerative disease is worth popularization and application because it is minimally invasive.
[Key words] Lumbar degenerative disease； Unilateral pedicle screw fixation； Intervertebral bone graft fusion； Effect
腰椎退行性病变是脊柱外科常见疾病之一，临床类型众多，包括腰椎间盘突出、腰椎滑脱、腰椎不稳定、腰椎管狭窄等，给患者的生活带来了极大的痛苦和不便[1]。大约80%的腰椎退行性疾病患者经保守治疗即可获得较好的效果，但是仍有部分患者保守治疗难以缓解，不得不进行手术治疗[2]。经典的手术方式是双侧椎弓根螺钉联合腰椎融合术，此术式虽可获得坚强的内固定，但是由于邻近节段应力过于集中容易引起相邻节段的退行性变。近年来单侧椎弓根联合椎体间植骨融合术逐渐得到了应用，并可以获得与双侧椎弓根螺钉相同的效果。该院自2011年6月以来使用单侧椎弓根螺钉固定联合椎体间植骨融合术治疗了多例腰椎退行性疾病患者取得了良好的效果，现报道如下。 (周若南 杨树东 孙士强)