后路腰椎间盘镜下胸腰椎椎弓根螺钉置钉技术的临床评价  

Clinical assessment of thoracolumbar transpedicle screw placement via posterior lamina in microendoscopic discectomy

作　　者：李开南[1] 聂海[1] 何智勇[1] 陈尔东[1] 汪学军[1] 员晋[1] 兰海[1] 龙涛[1] 

机构地区：[1]成都大学附属医院骨科,610081

出　　处：《中华创伤骨科杂志》2015年第9期770-775,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨后路腰椎间盘镜（MED）辅助胸腰椎椎弓根螺钉置钉技术的可行性、安全性和临床疗效. 方法 回顾性分析2008年7月至2013年9月收治的胸腰椎（T12至L2）骨折行单纯微创椎弓根螺钉内固定患者的临床资料,其中61例采用MED下置入普通椎弓根螺钉（MED组）,57例采用Sextant系统经皮穿刺置入空心椎弓根螺钉（Sextant组）,51例采用Viper系统经皮穿刺置入空心椎弓根螺钉（Viper组）.3组患者术前一般资料比较差异均无统计学意义（P＞0.05）,具有可比性.比较3组患者的手术切口长度、术中出血量、手术时间、透视次数、手术操作方便性评分、术后疼痛视觉模拟评分（VAS）、术后住院天数、住院总费用、并发症发生率和患者满意度. 结果 所有患者随访6～ 24个月.MED组与Sextant组、Viper组在切口长度、术中出血量、手术时间、术后VAS评分、术后住院天数以及并发症发生率、患者满意度调查差异均无统计学意义（P＞0.05）;与Sextant组和Viper组比较,MED组虽然操作繁琐,但透视次数少、平均住院费用低、不需要特殊器械和内置物. 结论 MED辅助实施椎弓根螺钉微创置钉,实现了微创可视下确定椎弓根螺钉的进钉点,使繁琐的C型臂X线机透视定位操作简化,有手术安全性高、手术风险可控性强等特点.Objective To explore feasibility,safety and efficacy of thoracolumbar transpedicle screw placement via posterior lamina aided by microendoscopic discectomy （MED）.Methods A retrospective study was performed of the patients with thoracolumbar fracture （from T12 to L2） who had been treated simply with minimally invasive endoscopic transpedicle screwing at our department from July 2008 to September 2013.Of them,61 received placement of ordinary transpedicle screws via posterior lamina aided by MED （the MED group）,and 57 percutaneous placement of hollow transpedicle screws of Sextant system （the Sextant group）,and 51 percutaneous placement of hollow transpedicle screws of Viper system （the Viper group）.The 3 groups were compatible in preoperative general data,showing no significant differences （P 〉 0.05）.The 3 groups were compared in terms of surgical incision,intraoperative bleeding loss,surgery duration,fluoroscopy frequency,surgical convenience,visual analog scale （VAS） score,hospital stay,total medical expenses and complications.Satisfaction degree of the patients was also evaluated.Results This series was followed up from 6 to 24 months.No significant differences were found between the 3 groups in surgical incision,intraoperative bleeding loss,surgery duration,VAS score,hospital stay,complications,or satisfaction degree of the patients （P 〉 0.05）.Compared with the Sextant and Viper groups,the MED needed less fluoroscopy frequency,lower medical expenses,and no special devices or implants,though it was more complicated.Conclusions Placement of transpedicle screws via posterior lamina aided by MED has advantages of direct visualization of pedicle screw insertion,simplified operation of C-Arm X-ray machine,surgical safety,and controlled surgical risks.

关 键 词：外科手术 微创性 脊柱骨折 骨折固定术 内 腰椎间盘镜 

分 类 号：R687.3[医药卫生—骨科学]