| 单侧椎弓根螺钉固定与联合对侧椎板关节突螺钉固定应用于下腰椎单节段病变的临床研究 |
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Received:October 16, 2014
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| 作者 | Author | 单位 | Unit | 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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, 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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, 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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| 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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
774374790@qq.com |
| 严卫锋 |
YAN Wei-feng |
武警部队骨科医学中心 武警浙江省总队医院, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 陈国军 |
CHEN Guo-jun |
武警部队骨科医学中心 武警浙江省总队医院, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, 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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, 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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, 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, 浙江 嘉兴 314000 |
Orthopaedics Medical Center of the Armed Police Forces, 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》2015年28卷，第4期，第306-312页 |
| DOI：10.3969/j.issn.1003-0034.2015.04.004 |
| 基金项目:浙江省卫生厅科研项目资助(编号:2010KYB112) |
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目的:对比单侧椎弓根螺钉固定并椎间融合器植骨与单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合器植骨两种手术方法治疗下腰椎单节段病变的临床优缺点。
方法:选择2008年1月至2009年6月收治的62例下腰椎单节段病变患者,男16例,女46例;年龄27～72岁,平均51.6岁。其中腰椎间盘退行性病变22例,腰椎间盘突出症术后原位复发13例,腰椎间盘突出伴椎管狭窄症12例,巨大型腰椎间盘突出症5例,腰椎退行性滑脱(Ⅰ度)10例。L3,4 5例,L4,5 42例,L5S1 15例。采用单侧椎弓根螺钉固定并椎间融合器植骨治疗30例(A组),采用单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合器植骨治疗32例(B组).对比两组患者的一般情况包括切口长度、手术时间、术中出血量、术后引流液量。根据影像资料观察内固定有无松动或断裂、椎间融合器有无移位、椎间融合情况,并比较两组患者术前、术后5 d和末次随访时病变节段椎间隙高度变化,以及术前和末次随访时腰椎冠状面和矢状面的Cobb角。对比两组病例术后72 h腰部切口疼痛程度,并采用JOA下腰痛评分系统评价临床疗效。
结果:两组病例术后切口无感染及皮肤坏死。未出现神经根或马尾损伤,以及下肢神经功能恶化现象。两组在切口长度、术中出血量和术后切口引流液量方面差异无统计学意义,而A组手术时间少于B组(P<0.05).术后72 h腰部切口VAS评分两组间比较差异无统计学意义(P>0.05).两组病例均获随访,随访时间12～48个月,平均27.5个月。在椎间隙高度方面,两组病例术后5 d与术前相比,均获得良好的恢复,且末次随访时与术后5 d相比,均获得良好的维持。两组病例均未出现椎弓根螺钉或椎板关节突螺钉松动、移位、断裂,亦未出现椎间融合器移位现象。两组融合率比较差异无统计学意义(P>0.05).两组病例末次随访时均获得良好的功能恢复,JOA评分与术前相比,差异有统计学意义(P<0.05),两组间相比差异无统计学意义(P>0.05).
结论:两种手术方式均具有切口小、创伤小、操作简单、稳定性可、植骨融合率高、恢复快、临床效果好及并发症少等优点。而且,与单侧椎弓根螺钉联合对侧椎板关节突螺钉固定方式相比,单侧椎弓根螺钉固定方式操作步骤少,不需要特殊器械,因而,在严格把握手术适应证、提高手术技巧的前提下,可在部分腰椎单节段病变的固定融合治疗中选择性应用。 |
| [关键词]:腰椎 椎弓根螺钉 椎板关节突螺钉 脊柱融合术 |
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| Unilateral pedicle screw fixation versus its combination with contralateral translaminar facet screw fixation for the treatment of single segmental lower lumbar vertebra diseases |
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Abstract:
Objective:To compare the advantages and disadvantages of unilateral pedicle screw fixation plus lumbar interbody fusion and unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation plus lumbar interbody fusion in treating single segmental lower lumbar vertebra diseases.
Methods:Sixty-two patients with single segmental lower lumbar vertebra disease who received treatment between January 2008 and June 2009. These patients were consisted of 16 males and 46 females, ranging in age from 27 to 72 years old, with a mean age of 51.6 years old. Among these patients, lumbar degenerative disease had in 22 patients, recurrence of lumbar intervertebral disc protrusion in 13 patients, lumbar intervertebral disc protrusion accompany with spinal canal stenosis in 12 patients, massive lumbar intervertebral disc protrusion in 5 patients and lumbar degenerative spondylolisthesis with degree Ⅰin 10 patients. The lesions occurred at L3,4 segment in 5 patients, at L4,5 segment in 42 patients, and at L5S1 segment in 15 patients. Thirty patients underwent unilateral pedicle screw fix ation (unilateral screw fixation group, group A) and thirty-two patients received unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation (bilateral screw fixation group, group B). Lumbar interbody fusion with intervertebral cages was also performed in all patients. Incision length, operation time, intraoperative blood loss and postoperative wound drainage were compared between two groups. Loosening or breakage of internal fixations, displacement of intervertebral cages and interbody fusion conditions were observed in each group. Preoperative and postoperative intervertebral height, coronal and sagittal Cobb angle and wound pain at 72 h after operation were compared between two groups. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the cinical effects.
Results:Neither wound infection, skin necrosis, nerve root or cauda equia injury, nor worsened neurological dysfunction in the lower limb occurred in each group. There were no significant differences in incision length, intraoperative blood loss and postoperative wound drainage between two groups. The operation time in group A was significantly shorter than that of group B(P<0.05). There were no significant differences in visual analogue scale value of the wound pain at postoperative 72 h between two groups(P>0.05). All patients were followed up for 12-48 months, with a mean of 27.5 months. The intervertebral height of all patients had obviously recovered at 5 days after operation, furthermore, at the final follow-up, it still had well maintained. During follow-up, no pedicle screw and/or translaminar facet screw loosening, displacement or breakage and displacement of intervertebral cages were found. The lumbar interbody fusion rate was 96.7% and 96.9% in group A and group B, respectively, and there was no significant difference between two groups (P>0.05). JOA score of all patients got obviously improved after operation (P<0.05), and there was no significant difference between two groups(P>0.05).
Conclusion:Both unilateral pedicle screw fixation plus lumbar interbody fusion and unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation plus lumbar interbody fusion have advantages of small incision, minimal invasion, simple operation, reliable stability, high interbody fusion rate, rapid recovery, encouraging clinical effects and less complications. Compared with unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation, the operation of unilateral pedicle screw fixation is simpler and can avoid using special equipments. Therefore, unilateral pedicle screw fixation plus lumbar interbody fusion can be used in treating single-segmental lower lumbar vertebra diseases under the precondition of strictly grasping indications for surgery and improving surgical skills. |
| KEYWORDS:Lumbar vertebrae Pedicle screws Translaminar facet screw 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,毛克亚,孙德弢,严卫锋,陈国军,宋永兴,张建乔,唐宏超,韩建福.单侧椎弓根螺钉固定与联合对侧椎板关节突螺钉固定应用于下腰椎单节段病变的临床研究[J].中国骨伤,2015,28(4):306~312 |
| 英文格式: | ZENG Zhong-you,WU Peng,MAO Ke-ya,SUN De-tao,YAN Wei-feng,CHEN Guo-jun,SONG Yong-xing,ZHANG Jian-qiao,TANG Hong-chao,HAN Jian-fu..Unilateral pedicle screw fixation versus its combination with contralateral translaminar facet screw fixation for the treatment of single segmental lower lumbar vertebra diseases[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(4):306~312 |
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