椎板关节突螺钉瞄准器在治疗下腰椎退行性病变的临床应用  

Clinic application of translamina facet screw aiming device in treating low lumbar degenerative disease

作　　者：曾忠友[1] 张建乔[1] 严卫锋[1] 汤永华[1] 陈国军[1] 金才益[1] 王斌[1] 江春宇[1] 吴鹏[1] 

机构地区：[1]武警浙江省总队医院骨二科武警部队骨科医学中心,浙江嘉兴南湖路16号314000

出　　处：《中国矫形外科杂志》2011年第5期378-381,共4页Orthopedic Journal of China

基　　金：浙江省卫生厅科研项目资助(编号:2010KYB112)

摘　　要：[目的]探讨在瞄准器引导下经皮行椎板关节突螺钉固定并联合椎间融合器置入治疗下腰椎退行性病变的可行性和疗效。[方法]自2007年6月～2008年6月共治疗下腰椎退行性病变26例,其中男性9例,女性17例;年龄29～70岁,平均52.0岁,病史1.5个月～30年,平均47.1个月,均有腰痛病史,伴双下肢放射4例,伴一侧下肢放射20例。疾病类型：腰椎间盘退行性病变19例,腰椎间盘突出症术后原位复发2例,腰椎退行性滑脱（Ⅰ度）3例,腰椎间盘突出伴椎管狭窄2例。病变部位：L4、5节段21例,L5S1节段3例,L3、4L4、51例,L4、5L5S11例。采用全麻,在瞄准器引导下经皮行椎板关节突螺钉固定并小切口完成椎管减压、髓核摘除及椎间融合器置入术。[结果]本组切口长3.8～5.9 cm,平均4.4 cm,手术时间55～100 min,平均72 min;术中出血量100～380 ml,平均190 ml,均未输血;术后切口引流量50～300 ml,平均162 ml。术后切口无感染、无皮肤坏死,术中、术后未出现马尾神经或神经根损伤以及下肢神经根功能恶化现象。所有病例均获随访,随访时间12～30个月,平均16.8个月,本组病例除1例不能明确外,其余均于术后6个月获得椎间融合,融合率为96.1%。随访过程中未发现螺钉松动、移位、断裂等现象,亦未出现椎间融合器移位现象,但大部分病例出现病变节段椎间隙高度下降,融合器部分陷入终板。最后随访时JOA评分由术前的11～16（平均13.1分）提高到21～27（平均24.6分）,改善率为60.6%～89.7%,平均71.6%。[结论]瞄准器引导下经皮行椎板关节突螺钉固定具有简单、准确和安全等优点,其联合椎间融合器置入是治疗下腰椎退行性病变的较好方法。[Objective]To investigate the feasibility and effect of the treatment of low lumbar degenerative disease with percutanous translamina facet screw by aiming device and placement of intervertebra cage. [Methods]Twenty-six patients of low lumbar degenerative disease（9 male and 17 female） received treatment,with mean age 52.0 years（range,29~70）,the mean medical history 47.1 months（from 1.5 months to 30 years）.All patients had back pain,and four patients with rediating pain in both legs,20 patients in one leg.All patients underwent discectomy,spinal canal decompression,cage implantation and lumbar fixation under the percutanous translamina facet screw by aiming device and small incisions.[Results]The mean length of incisions was 4.4 cm（from 3.8 to 5.9 cm）.With mean operation time 72 minutes（from 55 to 100 minutes）,and the blood loss was 190ml on average（range from 100 to 380 ml） in operation,162 ml（range from 50 to 300 ml） after operation.There was no incision infection,no cutaneous necrosis,no cauda equina and nerveroot injury,no deterioration of the neurological symptom.All patients were followed up with an average of 16.8 months（range,12~30 months）.Twenty-five cases got bony fusion,and poor bony fusion in 1 cases,the fusion rate was 96.1%,with no recurrence of instrumentation failure at follow-up.But the intervertebral space height declined in most of the cases,the cage trap in the endplate partly.The JOA grades changed from 13.1（11~16） preoperation to 24.6（21~27） at final follow-up,with the excellent to good rate of 71.6%（range,60.6%~89.7%）.[Conclusion]The percutanous translamina facet screw by aiming device is safe,simple and accurate,can gain good result in treatment of low lumbar degenerative disease combined with placement of intervertebra cage.

关 键 词：经皮 瞄准器 关节突固定 下腰椎 

分 类 号：R687.3[医药卫生—骨科学]