| 两种弹性固定系统在单节段腰椎间盘突出症髓核摘除术中的对照研究 |
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投稿时间：2022-05-05
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| 作者 | Author | 单位 | Address | E-Mail |
| 吴泽宣 |
WU Ze-xuan |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
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| 徐洪海 |
XU Hong-hai |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
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| 韩晓帆 |
HAN Xiao-fan |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
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| 李伟伟 |
LI Wei-wei |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
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| 段亮 |
DUAN Liang |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
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| 段大鹏 |
DUAN Da-peng |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
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| 杨俊生 |
YANG Jun-sheng |
西安医学院 陕西省人民医院, 陕西 西安 710000 |
Xi'an Medical College,Shaanxi Provincial People's Hospital,Xi'an 710000,Shaanxi,China |
yangzhurenllk@126.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第10期，第951-956页 |
| DOI：10.12200/j.issn.1003-0034.2022.10.008 |
| 基金项目:陕西省科技统筹创新工程计划项目(编号:2015KTCL03-02) |
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中文摘要:
目的:探讨两种弹性椎弓根内固定系统在单节段腰椎间盘突出症开窗髓核摘除术中的临床应用。
方法:对2019年6月至2021年3月采用手术治疗的64例腰椎间盘突出症患者进行回顾性分析,根据术中置入不同的弹性固定系统,分为使用普通椎弓根螺钉弹性棒连接固定组(弹性棒组)和特制弹性椎弓根螺钉刚性棒连接固定组(弹性钉组)。其中弹性棒组33例,男18例,女15例,年龄30~69(49.18±10.23)岁;弹性钉组31例,男16例,女15例,年龄32~68(49.81±9.24)岁。分别记录两组患者的手术时间、术中出血量、术后伤口引流量及术后下地时间,比较术前及术后3、12个月时的腰背疼痛视觉模拟评分(visual analogue scale,VAS),日本骨科协会(Japanese Orthopaedic Association,JOA)评分,Oswestry功能障碍指数(Oswestry Disability Index,ODI);测量术前及术后12个月侧位DR片上位邻近椎体间隙高度;采用Macnab标准评定临床疗效。
结果:两组患者均顺利完成手术并获随访。弹性棒组的手术时间、术中出血量、术后引流量及术后下地时间分别为(63.73±12.01) min、(89.55±16.07) ml、(81.67±16.00) ml、(3.45±0.75) d,弹性钉组为(62.96±11.54) min、(88.35±17.14) ml、(82.29±15.40) ml、(3.29±0.78) d,组间比较差异无统计学意义。所有患者术后腰痛及下肢麻木等症状明显改善,两组患者手术前后的VAS、JOA评分、ODI比较差异无统计学意义(P>0.05)。术后12个月上位邻近椎体间隙高度与术前同一节段椎体间隙高度比较,差异无统计学意义(P>0.05),手术前后组间差异无统计学意义。按照Macnab标准评定疗效,弹性棒组优30例,良2例,可1例;弹性钉组优29例,良2例,可0例,组间差异无统计学意义(Z=-0.42,P=0.68)。
结论:在腰椎间盘突出症开窗髓核摘除术中,两种弹性椎弓根内固定系统疗效相当,均可使用。而弹性钉内固定系统对于两椎体之间距离较短,在弹性棒不能放入或放入困难时具有一定的优势,使用更广泛。 |
| 【关键词】腰椎|椎间盘移位|手术|动态固定系统 |
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| Comparative study of two elastic fixation systems in single-segment lumbar disc herniation surgery for nucleus pulposus extraction |
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ABSTRACT
Objective: To investigate the clinical application of two elastic pedicle internal fixation systems in single-segment lumbar disc herniation fenestration.
Methods: A retrospective analysis of 64 patients with lumbar intervertebral disc herniation treated by surgery from June 2019 to March 2021. According to the different elastic fixation systems placed during the operation,the patients were divided into ordinary pedicle screw elastic rod link group (elastic rod group) and a special elastic pedicle screw rigid rod fixed connection group (elastic screw group). There were 33 cases in the elastic rod group,including 18 males and 15 females,aged from 30 to 69 years old with an average of(49.18±10.23) years old;and 31 cases in the elastic screw group,including 16 males and 15 females,aged from 32 to 68 with an average of (49.81±9.24) years old. The operation time,intraoperative blood loss,postoperative wound drainage,and postoperative landing time of the two groups were recorded separately. The visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score,and Oswestry Disability Index (ODI) were compared before and 3,12 months after operation. The height of the adjacent vertebral space on the lateral DR film before and 12 months after the operation was measured. The clinical efficacy was evaluated by Macnab standard.
Results: All the patients successfully completed the operation,and were followed up. The operation time,intraoperative blood loss,postoperative wound drainage and postoperative landing time in the elastic rod group were(63.73±12.01) min,(89.55±16.07) ml, (81.67±16.00) ml,(3.45±0.75) d,while in the elastic nail group was (62.96±11.54) min,(88.35±17.14) ml,(82.29±15.40) ml,(3.29±0.78) d,the difference was not statistically significant. The symptoms of low back pain and lower extremity numbness were significantly improved in all patients after operation. There was no significant difference in VAS,JOA score and ODI between the two groups before and after surgery (P>0.05). At 12 months after operation,there was no significant difference in the height of the adjacent vertebral space between the upper adjacent vertebral body and the same segment before operation(P>0.05),and there was no significant difference between the groups before and after the operation. According to Macnab criteria,the elastic rod group was excellent in 30 cases,good in 2 cases,fair in 1 case,while the elastic nail group was excellent in 29 cases,good in 2 cases,fair in 0 cases,and there was no significant difference(Z=-0.42,P=0.68).
Conclusion: In fenestrated nucleus pulposus extraction for lumbar disc herniation,the two elastic pedicle internal fixation systems are equally effective and can be used. The elastic screw internal fixation system has certain advantages when the distance between the two vertebral bodies is short,and the elastic rod cannot be placed or is difficult to be placed,and it is more widely used. |
| KEY WORDS Lumbar vertebrae|Intervertebral disk displacement|Surgery|Dynamic fixed system |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 吴泽宣,徐洪海,韩晓帆,李伟伟,段亮,段大鹏,杨俊生.两种弹性固定系统在单节段腰椎间盘突出症髓核摘除术中的对照研究[J].中国骨伤,2022,35(10):951~956 |
| 英文格式: | WU Ze-xuan,XU Hong-hai,HAN Xiao-fan,LI Wei-wei,DUAN Liang,DUAN Da-peng,YANG Jun-sheng.Comparative study of two elastic fixation systems in single-segment lumbar disc herniation surgery for nucleus pulposus extraction[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(10):951~956 |
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