直视法植入螺钉在腰椎退变性疾病椎弓根螺钉固定的应用  

Application of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation

作　　者：殷渠东 顾三军 孙振中 宋升 周子红[2] 程力[2] YIN Qu-dong;GU San-jun;SUN Zhen-zhong;SONG Shen;ZHOU Zi-hong;CHEN Li(Department of Orthopedics, Wuxi No.9 People's Hospital, Jiangsu Province 214062, China;Department of Orthopedics, Wuxi People's Hospital, Jiangsu Province,214000, China)

机构地区：[1]无锡市第九人民医院骨科,江苏无锡214062 [2]无锡市人民医院骨科,江苏无锡214000

出　　处：《中国临床解剖学杂志》2018年第6期690-693,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨直视法植入螺钉在腰椎退变性疾病椎弓根螺钉固定的应用效果。方法120例腰椎退变性疾病行后路切开椎弓根螺钉内固定治疗患者。按螺钉植入方式不同,分为以人字嵴为解剖标志的传统法组(A组,80例)和椎板切除或开窗后直视下以椎弓根内下缘为解剖标志的直视法组(B组,40例)。两组患者性别、年龄、病种、病程等一般资料比较,差异无统计学意义(P>0.05)。比较两组植入螺钉的透视时间、植入螺钉时间、术中出血量、融合率、功能恢复(JOA评定法)和并发症情况。结果B组的透视时间、植入螺钉时间和术中出血量小于A组,螺钉位置好于A组,差异有统计学意义(P<0.05);B组的功能恢复和并发症好于A组,但差异无统计学意义(P>0.05);两组融合率均100%。结论直视法植入椎弓根螺钉方法简单、效果良好,可以作为腰椎退变性疾病某些情况下传统法的一种补充。Objective To investigate the application effect of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation. Methods 120 patients with lumbar degenerative disease were treated with pedicle screw fixation by an open posterior approach. According to the placement method of pedicle screw, they were divided into group A with 80 cases using the traditional method adopting the crista lambdoidalis as anatomical marker for screw placement (group A, 80 cases), and group B with 40 cases using the media-inferior edge of the pedicle as the anatomical landmark for screw placement under direct vision after laminectomy or fenestration as anatomical mark. There was no statistically significant difference in general data between the two groups (P>0.05). The fluoroscopy time, placement time of pedicle screw, intraoperative blood loss, position of screw, fusion rate, functionary recovery (JOA score) and incidence of complications were recorded and compared between the two groups. Results The fluoroscopy time, placement time, intraoperative blood loss and the position of screw in group B were less or better than those in group A, and the differences were statistically significant (P<0.05); the functional recovery and complications in group B were better than those in group A, but the differences were not statistically significant (P>0.05); the fusion rate was 100% in both groups. Conclusions The method of pedicle screw placed under direct vision is simple and effective, which can be used as a supplement to traditional methods in some cases for degenerative diseases of lumbar spine.

关 键 词：椎弓根螺钉 腰椎退变性疾病 螺钉植入法 

分 类 号：R681.5[医药卫生—骨科学]