单边椎弓根螺钉固定在腰椎植骨融合术中应用及潜在问题分析  

Application and potential problem analysis of unilateral pedicle screw fixation in lumbar interbody fusion

作　　者：李俊博[1] 贾长青[1] 梁峰[1] 巴根[1] 柳达[1] 付勤[1] 

机构地区：[1]中国医科大学附属盛京医院脊柱关节外科,辽宁沈阳110001

出　　处：《生物医学工程与临床》2016年第5期508-513,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的观察单侧椎弓根钉固定（即单边固定）联合椎体间植骨融合治疗腰椎退变性疾病的临床效果,分析该术式可能存在的问题及解决办法。方法 40例腰椎间盘突出患者,分别行单边固定椎体间融合治疗和髓核摘除术治疗。单边固定组20例,其中男性12例,女性8例;年龄22~74岁,平均年龄53.9岁。髓核摘除组20例,其中男性11例,女性9例;年龄32~68岁,平均年龄49.8岁。记录手术时间、术中出血量、住院费用,再根据日本骨科协会（JOA）评分系统及视觉模拟量表（VAS）评分评价治疗效果。结果单边固定组手术时间、术中出血量、住院费用均多于髓核摘除组,差异有统计学意义（P〈0.05）。末次随访时单边固定组JOA评分为26.30±1.42,VAS评分为1.15±0.93;髓核摘除组JOA评分为25.05±2.82,VAS评分为1.60±1.23;两组间比较,差异无统计学意义。结论单边固定椎体间融合术有利于减轻患者的损伤和痛苦,以及承担相对较少的经济负担和获得肯定的疗效,值得推广应用,但要注意严格把握手术适应证,以避免融合失败。Objective To observe the effectiveness of unilateral pedicle screw fixation combined with lumbar interbody fusion in treatment of degenerative lumbar disease, and analyze the potential problems and solutions. Methods A total of 40 patients with protrusion of lumbar intervetebral disc were performed unilateral pedicle screw fixation combined with lumbar interbody fusion or discectomy. Twenty cases in unilateral fixation group, which included 12 males and 8 females, aged 22- 74 years old with mean age of 53.9 years old. Twenty cases in discectomy group, which included 11 males and 9 females, aged 32- 68 years old with mean age of 49.8 years old. The operation time, volume of intraoperative blood loss and hospitalized costs were recorded, and therapeutic effect was evaluated by Japanese Orthopaedic Association（JOA） score and visual analogue scale（VAS） score. Results The operative time, volume of intraoperative blood loss, hospitalized costs in unilateral fixation group were more than those in discectomy group. There was statistically significant differences between 2 group（ P〈0.05）. The final follow-up showed JOA score in unilateral fixation group was 26.30 ± 1.42 and VAS score was 1.15 ± 0.93; The JOA score in discectomy group was 25.05 ± 2.82 and VAS score in discectomy group was 1.60 ± 1.23, there was no statistical significance difference between 2 groups. Conclusion It is demonstrated that unilateral pedicle screw fixation combined with lumbar interbody fusion could reduce the pain and trauma to patient, which is worth promoting with relatively less costs and curative ef-fects. But the surgical indication should pay attention strictly to avoid fusion failure.

关 键 词：内固定 腰椎融合 椎弓根钉 腰椎退变性疾病 

分 类 号：R687.3[医药卫生—骨科学]