| 两种不同固定方式并椎间融合治疗腰椎双节段病变的临床对比研究 |
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投稿时间：2014-11-21
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| 作者 | Author | 单位 | Address | E-Mail |
| 曾忠友 |
ZENG Zhong-you |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 吴鹏 |
WU Peng |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 孙德弢 |
SUN De-tao |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 毛克亚 |
MAO Ke-ya |
解放军总医院骨科, 北京 100039 |
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| 张建乔 |
ZHANG Jian-qiao |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 籍剑飞 |
JI Jian-fei |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋永兴 |
SONG Yong-xing |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 韩建福 |
HAN Jian-fu |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋国浩 |
SONG Guo-hao |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 唐宏超 |
TANG Hong-chao |
武警部队骨科医学中心 武警浙江省总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
tanghc606@126.com |
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| 期刊信息：《中国骨伤》2015年，第28卷，第10期，第903-909页 |
| DOI：10.3969/j.issn.1003-0034.2015.10.006 |
| 基金项目:浙江省卫生厅科研项目资助(编号:2010KYB112) |
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中文摘要:
目的:通过与双侧椎弓根螺钉固定并椎间融合器植骨方法对比,探讨单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定并椎间融合器植骨方法治疗腰椎双节段病变的优缺点。
方法:选择2009年6月至2011年12月分别采用上述两种固定方法治疗的腰椎双节段病变49例,男17例,女32例,其中单侧椎弓根螺钉联合瞄准器引导下经皮对侧椎板关节突螺钉固定并椎间融合器植骨组(A组)23例,双侧椎弓根螺钉固定并椎间融合器植骨组(B组)26例。腰椎间盘突出伴椎管狭窄症29例,腰椎间盘退变17例,腰椎退行性滑脱(Ⅰ度)3例;L2,3、L3,4 1例,L3,4、L4,5 30例,L4,5、L5S1 18例。对比两组病例切口长度、手术时间、术中出血量、术后引流液量。根据影像资料对比两组病例手术前后病变节段椎间隙高度的变化、腰椎冠状面和矢状面Cobb角变化,观察椎弓根螺钉、椎板关节突螺钉有无松动、断裂,以及椎间融合器有无移位,评价椎间融合情况。采用视觉模拟评分法(visual analogue scale,VAS)对腰部切口疼痛进行评分。术前、末次随访采用JOA下腰痛评分系统,评价两组病例的功能恢复情况。
结果:术后切口无感染及皮肤坏死。术中、术后未出现脑脊液漏,未出现马尾或神经根损伤以及下肢神经根功能恶化现象。两组病例切口长度、手术时间、术中出血量和术后切口引流液量对比,A组优于B组。术后72 h,VAS评分A组为2.35±1.20,B组3.11±1.00,两组差异有统计学意义(P<0.05).所有患者获随访,时间12～48个月,平均29个月。所有患者椎间隙高度获得良好的恢复,并有良好的维持,两组比较差异无统计学意义(P>0.05).未出现椎板关节突螺钉或椎弓根螺钉松动、移位、断裂,亦未出现椎间融合器移位现象。末次随访时两组病例的腰椎冠状面和矢状面Cobb角均获得良好的改善,两组间比较差异无统计学意义(P>0.05).融合率A组为93.5%,B组为96.2%,两组比较差异无统计学意义(P>0.05).末次随访时JOA评分均较术前改善(P<0.01),两组差异有统计学意义(P<0.05).
结论:与双侧椎弓根螺钉固定相比,单侧椎弓根螺钉联合瞄准器引导下经皮对侧椎板关节突螺钉固定并椎间融合器植骨方式治疗腰椎双节段病变具有切口小、创伤小、操作简单、稳定性好、融合率高、恢复快等优点,可作为部分腰椎双节段病变病例固定融合的较好选择。 |
| 【关键词】腰椎 椎间盘移位 椎管狭窄 脊柱融合术 |
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| Two different fixation methods combined with lumbar interbody fusion for the treatment of two-level lumbar vertebra diseases:a clinical comparison study |
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ABSTRACT
Objective:To investigate the advantages and disadvantages of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion with cages in the treatment of two-level lumbar vertebra diseases,by comparing bilateral pedicle screw fixation and interbody fusion with cages.
Methods:Forty-nine patients with two-level lumbar diseases who received treatments from June 2009 to December 2011 were included in this study. Among these patients,23 patients received unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion with cages (combined fixation group),and the remaining 26 patients underwent bilateral pedicle screw fixation and interbody fusion with cages (bilateral fixation group). These patients consisted of 17 males and 32 females,ranging in age from 29 to 68 years old. Among these patients,lumbar intervertebral disc herniation accompanied by the spinal canal stenosis was found in 29 patients,degenerative lumbar disc diseases in 17 patients and lumbar degenerative spondylolisthesis (degreeⅠ) in 3 patients. The lesions occurred at L2,3 and L3,4 segments in 1 patient,at L3,4 and L4,5 segments in 30 patients,and at L4,5 segment and L5S1 segment in 18 patients. Wound length,operation time,intraoperative blood loss and postoperative wound drainage were compared between two groups. Intervertebral space height in the lesioned segment before and during surgery and at the latest follow up was also compared between two groups. Before surgery and at the latest follow-up,the Cobb angle of the coronal plane and sagittal plane of the lumbar spine,loosening or breakage of internal fixations,the dislocation of intervertebral cages,and interbody fusion were all evaluated in each group. The visual analogue scale (VAS) was used to measure lumbar incision pain. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the function before surgery and at the latest follow-up.
Results:No wound infection or skin necrosis was observed after surgery in all patients. No cerebrospinal fluid leakage,nerve root injury,cauda equia injury or worsened neural function in the lower limb occurred in all patients during and after surgery. Wound length,operation time,intraoperative blood loss and postoperative wound drainage in the combined fixation group were superior to those in the bilateral fixation group. At postoperative 72 hours,the VAS score in the combined fixation group (1 to 4 points,mean 2.35±1.20) was significantly lower than that in the bilateral fixation group (2 to 5 points,mean 3.11±1.00;P<0.05). All the patients were followed up for 12 to 48 months,with a mean of 29 months. After surgery,intervertebral space height was well recovered in each patient and it was well maintained at the latest follow-up,and there was no significant difference between two groups (P>0.05). During follow-up,pedicle screw and translaminar facet screw loosening,dislocation or breakage and dislocation of intervertebral cages were all not found. At the latest follow-up,the Cobb angle of the coronal plane and sagittal plane of the lumbar spine was obviously improved and was not significantly different between two groups (P>0.05). The lumbar interbody fusion rate was 93.5% and 96.2% in the combined fixation group and bilateral fixation group,respectively,and there was no significant difference between them(P>0.05). There was a significant difference in JOA score between before surgery and at the latest follow-up in each patient (P <0.05),and at the latest follow-up,significant difference in JOA score was found between two groups(P<0.05).
Conclusion:Compared to bilateral pedicle screw fixation and lumbar interbody fusion with cages,unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and lumbar interbody fusion with cages shows advantages including small skin incision,minimal invasion,ease of operation,highly reliable stability,high interbody fusion rate,rapid recovery in the treatment of two-level lumbar vertebra diseases and therefore can be preferred as a treatment method of this disease. |
| KEY WORDS Lumbar vertebrae Intervertebral disk displacement Spinal stenosis Spinal fusion |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 曾忠友,吴鹏,孙德弢,毛克亚,张建乔,籍剑飞,宋永兴,韩建福,宋国浩,唐宏超.两种不同固定方式并椎间融合治疗腰椎双节段病变的临床对比研究[J].中国骨伤,2015,28(10):903~909 |
| 英文格式: | ZENG Zhong-you,WU Peng,SUN De-tao,MAO Ke-ya,ZHANG Jian-qiao,JI Jian-fei,SONG Yong-xing,HAN Jian-fu,SONG Guo-hao,TANG Hong-chao.Two different fixation methods combined with lumbar interbody fusion for the treatment of two-level lumbar vertebra diseases:a clinical comparison study[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(10):903~909 |
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