通道下联合固定并椎间融合术治疗腰椎病变的早期并发症  

Channel-assisted combined fixation and interbody fusion for treating lumbar vertebra diseases:an early complication observation

作　　者：曾忠友[1] 宋永兴[1] 吴鹏[1] 张建乔[1] 严卫锋[1] 唐宏超[1] 毛克亚[2] 

机构地区：[1]武警部队骨科医学中心武警浙江省总队医院骨二科,浙江嘉兴314000 [2]解放军总医院骨科,北京100853

出　　处：《中国矫形外科杂志》2016年第17期1537-1544,共8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]分析通道下肌间隙入路单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗腰椎病变的早期并发症。[方法]男47例，女65例；年龄29～79岁，平均55．1岁。疾病类型：腰椎间盘退变50例，腰椎间盘突出症术后原位复发13例，巨大型腰椎间盘突出10例，腰椎间盘突出伴椎管狭窄14例，极外侧型腰椎间盘突出症8例，腰椎退行性滑脱（I度）17例。单节段病变93例，双节段病变19例。采用通道下肌间隙入路单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗，观察其早期并发症的发生情况。[结果]术中出现腰椎病变节段定位错误3例、异常出血2例、硬脊膜撕裂并脑脊液漏1例、椎弓根骨折3例、终板损伤2例。术后出现切口问题10例、血肿形成2例、神经损伤5例、椎弓根螺钉位置不正确3例、椎板关节突螺钉位置不正确10例、再次手术2例、融合器移位1例。并发症发生率为32．1％。[结论]通道下肌间隙入路单侧椎弓根螺钉联合瞄准器引导下对侧椎板关节突螺钉固定并椎间融合器植骨治疗腰椎病变的早期并发症发生率较高，特别是在开展的早期阶段。并发症的发生除了与手术方式密切相关，病例和融合器的选择、手术操作亦是重要的因素。只要严格手术适应证的选择、细致的手术操作，以及影像系统的辅助应用，并保持循序渐进，可有效地降低并发症的发生。[ Objective] To analyze the causes of early comphcations after treatment of the lumbar vertebra diseases with u- nilateral pedicle screw combined with contralateral translaminar facet screw fixation under sighting telescope guiding and inter- body fusion cage fixation through channel -assisted approach. [ Methods] This study enrolled 47 males and 65 females, with the age of 29 -79 years （mean, 55. 1 years） . Type of disease were confirmed as 50 cases of lumbar disc degeneration, 13 ca- ses of recurrence in situ after lumbar disc herniation surgery, 10 cases of huge lumbar disc herniation, 14 cases of lumbar disc herniation with spinal canal stenosis, 8 cases of extreme lateral lumbar disc herniation, and 17 cases of lumbar degenerative spondylolisthesis （degree I） . In all cases, 93 cases were found with single segment lesion and another 19 cases with double segment lesion. All cases were operated by unilateral pedicle screw combined with contralateral translaminar facet screw fixation under sighting telescope guiding and interbody fusion cage using channel - assisted by muscle - splitting approach. After opera- tion, the early complications were observed and the reason were investigated. [ Results] During the operation, error location of lumbar segments was found in three cases, abnormal bleeding in two cases, dural laceration and cerebrospinal fluid leakage in one case, pedicle fractures in three cases, and end plate damage in two cases. After the operation, incision problems were observed in 10 cases, hematoma formation in 2 cases, nerve injury in 5 cases, incorrect position of pedicle screw in 3 cases, incorrect position of translaminar facet screw in 10 cases, and re - operation was needed in 2 cases. Within 3 months of follow - up, there was no loosening, displacement or breakage of pedicle screws and translaminar facet screws. Interbody fusion cage displaced backward in 1 case. Complication rate was 32. 1%. [ Conclusion ] The rate of early complications of unilateral pedicle screw combined with con

关 键 词：腰椎 椎弓根螺钉 椎板关节突螺钉 融合 并发症 

分 类 号：R687.3[医药卫生—骨科学]