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正中切口联合固定并椎间融合术治疗腰椎病变的中长期随访结果

Combined fixation and interbody fusion in the treatment of lumbar spine lesions through median incision mid-long term follow-up results

摘要:

目的:总结正中切口单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗腰椎单节段和两节段病变的中长期随访结果,并分析该技术的注意事项。方法:回顾性分析2008年1月至2013年12月共72例采用正中切口入路单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗的腰椎单节段和两节段病变患者,并获得>5年随访且资料完整,其中男28例,女44例;年龄(51.23±10.16)岁(范围24~72岁)。病程(46.5±47.60)个月(范围8~360个月);疾病类型:腰椎间盘退行性病变26例、腰椎间盘突出症术后原位复发8例、巨大型腰椎间盘突出11例、腰椎管狭窄症14例、腰椎退行性滑脱(Ⅰ度)10例、极外侧型腰椎间盘突出3例。单节段病变55例,两节段病变17例。病变部位:L 3,4 2例,L 4,5 43例,L 5S 1 10例,L 3,4及L 4,5 11例,L 4,5及L 5S 1 6例。均采用正中切口显露、单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗,观察其5年或以上随访结果和并发症情况。 结果:术中未出现硬脊膜损伤和脑脊液漏,出现椎弓根入点处骨折3例、终板损伤4例;切口皮肤无坏死、无感染。神经根损伤1例,考虑为椎弓根螺钉位置不正确顶压所致,予螺钉调整术。获得(81.52±12.34)个月(范围60~108个月)的随访,未发现有症状的深静脉栓塞。随访过程中出现融合器沉降17例23个节段。术后病变节段椎间隙高度均获得较好的恢复,但在随访中出现明显的丢失。所有节段均获得椎间融合,融合率为100%。未发现内固定松动或断裂,椎间融合器无移位。出现邻近节段退变4例。腰痛VAS评分由术前的平均(5.45±0.87)分至末次随访时的平均(0.72±0.54)分,与术前对比差异有统计学意义( t=14.658, P<0.05)。JOA评分由术前的平均(12.77±2.57)分提高到最后随访时的平均(27.1±1.68)分,与术前对比差异有统计学意义( t=10.131, P<0.05)。 结论:正中切口单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗腰椎单节段或两节段病变,既有操作的便利性、快捷性、安全性,亦有生物力学方面的优势,且中长期随访结果良好、邻近节段退变率低、无严重并发症或永久性损害,可作为部分腰椎病变固定融合的较好选择。

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abstracts:

Objective:To summary the mid-long term follow-up results of unilateral pedicle screw combined with contralateral translaminar facet screw fixation by gunsight guiding and interbody fusion in the treatment of lumbar spine lesions through median incision.Methods:We retrospectively analyzed a total of 72 patients who were treated by unilateral pedicle screw combined with contralateral translaminar facet screw fixation by gunsight guiding and interbody fusion from January 2008 to December 2013. All the patients had more than 5 years follow-up. These patients, including 28 males and 44 females, ranging in age from 24 to 72 years, with a mean age of 51.2 years. The mean medical history was from 8 months to 30 years (meanly 46.5±47.60 months). Disease types included: lumbar disc degenerative diseases in 26 cases, recurrence lumbar disc herniation in 8 cases, giant lumbar disc herniation in 11 cases, lumbar spinal stenosis in 14 cases, degenerative spondylolisthesis (degree I) in 10 cases, extreme lateral lumbar disc herniation in 3 cases. In addition, the lesion sites included L3/4 in 2 cases, L4/5 in 43 cases, L5S1 in 10 cases, L3/4 L4/5 in 11 cases and L4/5 L5S1 in 6 cases. All the cases were treated by unilateral pedicle screw combined with contralateral translaminar facet screw fixation by gunsight guiding and interbody fusion through median incision, and the 5 years or more follow-up results and complications were observed.Results:There was no spine dura mater injury and cerebrospinal fluid leak, while there were 3 cases of pedicle fracture and 4 cases of endplate injury. There was no incision skin infection, incision necrosis and cerebrospinal fluid leak, and there was 1 case of nerve root injury observed. The mean follow-up time was 81.52±12.34 months (from 60 to 108 months). The cage subsidence was observed in 17 cases (23 segments). The intervertebral height of lesion segment was recovered after surgery, and obvious loss during the follow-up time. All the segments took well interbody fusion, with the rate of 100%. There was no pedicle screw or translaminar facet screw loosen and no cage migration. However, 4 cases of adjacent segment degeneration were observed. The lumbar VAS score significantly decreased from 5.451±0.87 pre-operation to 0.72±0.54 at the last follow-up. The JOA score significantly increased from 12.77±2.57 pre-operation to 27.1±1.68 at the last follow-up.Conclusion:Unilateral pedicle screw combined with contralateral translaminar facet screw fixation by gunsight guiding and interbody fusion in the treatment of lumbar spine lesions through median incision not only has advantages of convenience, rapidity and safety, but also has satisfied clinical results of mid-long term follow-up and low complication rate. And this technique can be a good choice in treatment of partial lumbar diseases.

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作者: 曾忠友 [1] 俞伟 [1] 宋永兴 [1] 张建乔 [1] 韩建福 [1] 宋国浩 [1] 范时洋 [1]
作者单位: 武警部队骨科中心,武警海警总队医院骨二科,嘉兴 314000 [1]
期刊: 《中华骨科杂志》2020年40卷24期 1646-1658页 ISTICPKUCSCDCA
栏目名称: 临床论著
DOI: 10.3760/cma.j.cn121113-20200303-00127
发布时间: 2021-01-11
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