| 两种固定方式在单侧双通道脊柱内镜技术下单节段椎间融合固定术中的对照研究 |
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投稿时间：2024-10-24
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| 作者 | Author | 单位 | Address | E-Mail |
| 吴泽宣 |
WU Ze-xuan |
西安高新医院, 陕西 西安 710000 |
Xi'an Gaoxin Hospital, Xi'an 710000, Shaanxi, China |
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| 王涛 |
WANG Tao |
西安高新医院, 陕西 西安 710000 |
Xi'an Gaoxin Hospital, Xi'an 710000, Shaanxi, China |
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| 雷志刚 |
LEI Zhi-gang |
西安高新医院, 陕西 西安 710000 |
Xi'an Gaoxin Hospital, Xi'an 710000, Shaanxi, China |
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| 李晓林 |
LI Xiao-lin |
陕西省人民医院, 陕西 西安 710068 |
Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China |
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| 刘浩哲 |
LIU Hao-zhe |
陕西省人民医院, 陕西 西安 710068 |
Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China |
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| 李晓阳 |
LI Xiao-yang |
陕西省人民医院, 陕西 西安 710068 |
Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China |
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| 白信信 |
BAI Xin-xin |
陕西省人民医院, 陕西 西安 710068 |
Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China |
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| 徐洪海 |
XU Hong-hai |
陕西省人民医院, 陕西 西安 710068 |
Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China |
xuhonghai1963@126.com |
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| 期刊信息：《中国骨伤》2024年，第37卷，第12期，第1158-1163页 |
| DOI：10.12200/j.issn.1003-0034.20230644 |
| 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: 探讨单侧钉棒系统固定和双侧钉棒系统固定对腰椎间盘突出症(lumbar disc herniation,LDH)合并失稳在单侧双通道脊柱内镜技术下单节段椎间融合固定术中的临床疗效。
方法: 回顾性分析2021年3月至2022年6月采用单侧双通道脊柱内镜技术治疗63例LDH合并失稳患者的临床资料,根据术中固定方式分为单侧钉棒系统固定组(单侧组)和双侧钉棒系统固定组(双侧组)。单侧组31例,男15例,女16例,年龄40~67(54.65±7.32)岁;L3,43例,L4,5 15例,L5S1 13例。双侧组32例,男18例,女14例,年龄43~68(56.19±6.63)岁;L3,4 4例,L4,5 17例,L5S1 11例。记录并比较两组手术时间、手术切口长度、术后下地时间、住院时间、治疗费用以及并发症和不良事件的发生情况;比较术前及术后3、12个月腰腿痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分和Oswestry功能障碍指数(Oswestry disability index,ODI);并采用MacNab标准评价临床疗效。
结果: 两组顺利完成手术并获得随访。单侧固定组随访时间、手术时间、手术切口长度、术后下地时间、住院时间及治疗费用分别为(11.81±1.08)个月、(122.48±13.86) min、(3.15±0.45) cm、(3.06±0.73) d、(6.87±1.09) d、(3.49±0.09)万元,双侧固定组分别为(11.47±1.16)个月、(134.94±10.94) min、(6.45±0.83) cm、(3.19±0.86) d、(7.03±1.03) d、(3.77±0.12)万元;两组手术时间、切口长度、治疗费用比较,差异有统计学意义(P<0.05);而随访时间、术后下地时间、住院时间比较,差异无统计学意义(P>0.05)。两组间手术前后腰痛、腿痛VAS,JOA评分、ODI及MacNab等级比较,差异无统计学意义(P>0.05)。两组治疗后未见明显的并发症及不良事件发生。
结论: 单侧钉棒系统和双侧钉棒系统固定在单侧双通道脊柱内镜技术治疗LDH合并失稳时,均能达到预期的效果。单侧固定较双侧固定在手术时间、切口长度及治疗费用上更具优势。对于术前存在骨质疏松症或术中发现单侧椎弓根钉固定强度不足的患者,可行双侧固定,以增强固定的可靠性。 |
| 【关键词】腰椎间盘突出症 脊柱融合手术 腰椎不稳 |
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| Comparative study of two fixation methods in single segment interbody fusion and fixation with unilateral dual channel spinal endoscopic technique |
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ABSTRACT
Objective To explore clinical efficacy of unilateral and bilateral nail-rod system fixation in single-level intervertebral fusion fixation of lumbar disc herniation (LDH) and instability with unilateral dual-channel spinal endoscopy.
Methods The clinical data of 63 patients with LDH complicated with instability treated by unilateral double-channel spinal endoscopy from March 2021 to June 2022 were retrospectively analyzed. According to intraoperative fixation methods,the patients were divided into two groups,included unilateral nail rod system fixation group(unilateral group) and bilateral nail rod system fixation group(bilateral group). There were 31 patients in unilateral group,including 15 males and 16 females; aged from 40 to 67 years old with an average of (54.65±7.32) years old; 3 patients with L3,4,15 patients with L4,5,13 patients with L5S1. There were 32 patients in bilateral group,including 18 males and 14 females,aged from 43 to 68 years old with an average of (56.19±6.63) years old;4 patients with L3,4,17 patients with L4,5,11 patients with L5S1. The time of operation,length of incision,operation time,length of hospital stay,cost of treatment,occurrence of complications and adverse events were recorded and compared between two groups. Visual analogue scale (VAS) of lumbar and leg pain,Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) were compared before operation,3 and 12 months after operation. MacNab standard was used to evaluate clinical effect.
Results Both of two groups were successfully completed operation and followed up. In unilateral fixation group,follow-up time,operation time,incision length,postoperative ambulation time,hospital stay and treatment cost were (11.81±1.08) months,(122.48±13.86) min,(3.15±0.45) cm,(3.06±0.73) d,(6.87±1.09) d,and (3.49±0.09) ten thousand yuan;while (11.47±1.16) months,(134.94±10.94) min,(6.45±0.83) cm,(3.19±0.86) d,(7.03±1.03) d,(3.77±0.12) ten thousand yuan in bilateral fixation group,respectively;there were significant differences in operation time,incision length and treatment cost between two groups (P<0.05),no significant difference in follow-up time,postoperative ambulation time and hospital stay (P>0.05). There were no significant difference in VAS of low back pain,JOA score,ODI and MacNab grade between two groups before and after operation (P>0.05). No significant complications and adverse events were observed between two groups after operation.
Conclusion Both of unilateral and bilateral nail rod system for the treatment of LDH with instability could achieve the expected results. Unilateral fixation has more advantageous than bilateral fixation in terms of operation time,incision length and treatment cost. For patients with osteoporosis before operation or insufficient fixation strength of unilateral pedicle nails during surgery,bilateral fixation is feasible to enhance reliability of fixation. |
| KEY WORDS Lumbar disc herniation Spinal fusion Lumbar instability |
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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,王涛,雷志刚,李晓林,刘浩哲,李晓阳,白信信,徐洪海.两种固定方式在单侧双通道脊柱内镜技术下单节段椎间融合固定术中的对照研究[J].中国骨伤,2024,37(12):1158~1163 |
| 英文格式: | WU Ze-xuan,WANG Tao,LEI Zhi-gang,LI Xiao-lin,LIU Hao-zhe,LI Xiao-yang,BAI Xin-xin,XU Hong-hai.Comparative study of two fixation methods in single segment interbody fusion and fixation with unilateral dual channel spinal endoscopic technique[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1158~1163 |
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