| 小切口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治疗腰椎病变的并发症分析 |
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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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| 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 |
jxyxybgs@163.com |
| 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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| 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 |
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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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| 期刊信息：《中国骨伤》2016年，第29卷，第3期，第232-241页 |
| DOI：10.3969/j.issn.1003-0034.2016.03.008 |
| 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:总结小切口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治疗腰椎病变并发症的发生特点和原因。方法:对2008年1月至2013年12月采用小切口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治疗的166例腰椎病变患者进行回顾性分析,其中男64例,女102例;年龄24～74岁,平均51.9岁;病程8个月～30年,平均47.5个月;腰椎间盘退变49例,腰椎间盘突出症术后原位复发17例,巨大型腰椎间盘突出23例,腰椎间盘突出伴椎管狭窄27例,腰椎退行性Ⅰ度滑脱(Meyerding分级系统)21例,极外侧型腰椎间盘突出5例;单节段病变124例,双节段病变42例;L3,4 6例,L4,5 97例,L5S1 21例,L2,3、L3,4 1例,L3,4、L4,5 26例,L4,5、L5S1 15例。结果:166例患者术中无异常出血,均未输血;术中硬脊膜损伤并脑脊液漏1例、椎弓根(椎弓根入点)骨折4例、终板损伤2例。切口皮肤无坏死,切口无感染。术后未出现脑脊液漏,神经根损伤1例。椎弓根螺钉位置Ⅰ度163例371枚螺钉,Ⅱ度3例3枚螺钉;椎板关节突螺钉Ⅰ型157例199枚螺钉,Ⅱ型8例8枚螺钉,Ⅲ型1例1枚螺钉;椎板关节突螺钉偏短2例。失访5例,死亡2例,其余病例获得12～60个月的随访,平均35.4个月。随访过程中出现终板切割并融合器部分嵌入椎体14例14个节段。出现异常的双下肢疼痛1例。除11例11个节段不能明确外,其余148例189个节段获得椎间融合。未发现椎弓根螺钉与椎板关节突螺钉松动、移位、断裂,椎间融合器亦无前后向移位,未观察到邻近节段的明显退变现象。末次随访时腰椎冠状面Cobb角、矢状面Cobb角及JOA评分较术前均有明显的改善。结论:虽然小切口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治疗腰椎病变是一较好的手术方式,但仍面临着并发症的问题,要求术者具有丰富的脊柱外科手术经验、术中严谨的操作、充分利用影像辅助系统,以有效地降低手术并发症的发生。 |
| 【关键词】腰椎 椎弓根螺钉 椎板关节突螺钉 脊柱融合术 手术后并发症 |
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| Unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion for the treatment of lower lumbar diseases:an analysis of complications |
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| ABSTRACT Objective:To investigate the features and causes of complications of unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion in treating lower lumbar diseases. Methods:The clinical data of 166 patients with lower lumbar diseases who underwent unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages from January 2008 to December 2013 were retrospectively analyzed. There were 64 males and 102 females, aged from 24 to 74 years with a mean of 51.9 years old, suffered from lower lumbar lesions for 47.5 months on average (ranged, 8 months to 30 years). Among these patients, lumbar intervertebral disc degeneration was found in 49 patients, recurred lumbar intervertebral disc protrusion in 17 patients, massive lumbar intervertebral disc protrusion in 23 patients, lumbar intervertebral disc protrusion accompany with spinal canal stenosis in 27 patients, lumbar degenerative spondylolisthesis with degreeⅠ(Meyerding grade) in 21 patients, far lateral lumbar intervertebral disc protrusion in 5 patients. Single segmental diseases occurred in 124 patients and two segmental diseases in 42 patients. The diseases occurred at L3, 4 segment in 6 patients, at L4, 5 segment in 97 patients, at L5S1 segment in 21 patients, at L2, 3 and L3, 4 segments in 1 patient, at L3, 4 and L4, 5 segments in 26 patients, and at L4, 5 and L5S1 segments in 15 patients. Results:There was no abnormal bleeding in the patients and no patient received blood transfusion. During the surgery, spinal dura mater injury with cerebrospinal fluid leakage complicated in 1 patient, a fracture of vertebral pedicle in 4 patients, and end plate injury in 2 patients. No postoperative cerebrospinal fluid, incision infection and skin necrosis were found after operation. Nerve root injury was found in 1 patient. According to the position of pedicle screw, 371 screws of 163 patients were in degreeⅠand 3 screws of 3 patients were in degreeⅡ;position of translaminar facet screw, 199 screws of 157 patients were typeⅠ, 8 screws of 8 patients were typeⅡ, 1 screw of 1 patient was type Ⅲ。 Translaminar facet screw was slightly short in 2 patients. Five patients were lost to follow-up, two patients were died. The remaining patients were followed up for 35.4 months on average(ranged, 12 to 60 months). During the follow-up period, end plate was cut off and intervertebral cages were embedded in 14 segments of 14 patients. Abnormal pain of both lower extremities was found in 1 patient. With the exception of 11 unidentified segments in 11 patients, 189 segments of 148 patients obtained intervertebral fusion. No loosening, displacement, breakage of pedicle screw or translaminar facet screw, displacement of intervertebral cages or obvious degeneration of adjacent segments were found. The coronal and sagittal planes balance of lumbar vertebra were obviously improved. Postoperative JOA score was significantly increased than that of preoperative. Conclusion:Unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages is a good choice for the treatment of lower lumbar diseases, but it has a risk of complications. Abundant surgeon's surgical experience, careful operation, and rational use of imaging technique can effectively reduce the incidence of complications. |
| KEY WORDS Lumbar vertebra Pedicle screws Translaminar facet screws Spinal fusion Postoperative complication |
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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,宋永兴,张建乔,唐宏超,籍剑飞.小切口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治疗腰椎病变的并发症分析[J].中国骨伤,2016,29(3):232~241 |
| 英文格式: | ZENG Zhong-you,WU Peng,SONG Yong-xing,ZHANG Jian-qiao,TANG Hong-chao,JI Jian-fei.Unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion for the treatment of lower lumbar diseases:an analysis of complications[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(3):232~241 |
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