单侧经皮椎弓根螺钉固定椎体间融合治疗多节段椎管狭窄  

Unilateral pedicle screw fixation combined with lumbar interbody fusion for the treatment of multi-level lumbar spinal stenosis

作　　者：周旭 丁悦 纪斌[1] 王明飞[1] 贺石生[2] ZHOU Xu DING Yue JI Bin WANG Ming-fei HE Shi-sheng(Putuo Hospital, Shanghai University of Traditional Chinense Medicine, Putuo, Shanghai, 200062, Chin)

机构地区：[1]上海中医药大学附属普陀医院,200062 [2]上海市第十人民医院,200072

出　　处：《中国骨与关节杂志》2017年第10期752-757,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨经椎间孔腰椎体间融合术(transfnraminal lumbar interbody fusion,TLIF)辅以经皮单侧椎弓根螺钉固定技术治疗多节段腰椎管狭窄的可行性及有效性。方法回顾性分析2009年8月至2010年8月,我院收治的因患多节段腰椎管狭窄疾病行腰椎后路融合术并获得随访的患者25例。采用经皮单侧椎弓根螺钉固定TLIF技术治疗11例(单侧组),其中男7例,女4例;其中L_2～5节段5例,L_3～S_1节段6例;年龄31～64岁,平均47.6岁。采用经皮双侧椎弓根螺钉固定TLIF技术治疗14例(双侧组),其中男8例,女6例;其中L_(1～4)节段1例,L_(2～5)节段5例,L_3～S_1节段8例;年龄26～66岁。平均50.5岁。使用日本骨科协会(Japanese orthopaedic association,JOA)评分评估两组患者术后疗效,并比较两组患者手术时间、失血量、术后自主翻身时间、术后下床活动时间、并发症、植骨融合率、住院花费等指标。结果单侧组术前、术后JOA评分分别为(8.55±2.96)分和(25.09±8.92)分,双侧组分别为(8.79±3.37)分和(25.00±7.49)分。单侧组手术时间、出血量、术后自主翻身时间、术后下床活动时间和住院总费用分别为(177.27±30.48)min、(220.91±34.46)ml、(1.73±1.10)天、(9.45±2.69)天、(65676.82±2149.83)元,双侧组分别为(130.71±40.02)min、(311.43±57.45)ml、(2.43±1.49)天、(9.29±2.61)天、(95774.29±2015.19)元。两组患者术后融合率分别为90.9%(30/33)和92.9%(39/42)。两组术后JOA评分明显改善,且手术前后两组患者的JOA评分比较差异均有统计学意义(P<0.05)。两组患者术后下床活动时间、手术优良率、手术并发症、植骨融合率方面比较差异无统计学意义(P>0.05)。两组患者手术时间、出血量、术后自主翻身时间及住院费用比较差异均有统计学意义(P<0.05)。结论经椎间孔多节段椎间植骨融合辅以经皮单侧椎弓根螺钉固定能提供较好的脊柱即刻稳定性。TLIF结合经皮单侧椎弓根螺钉固�Objective To explore the feasibility and effects of transfnraminal lumbar interbody fusion（ TLIF） combined with unilateral pedicle screw fixation in the treatment of multi-level lumbar spinal stenosis. Methods From August 2009 to October 2010, 25 cases with the lumbar spinal stenosis who received lumbar posterolateral fusion were analyzed. There were 11 cases of TLIF with unilatera I pedicle screw fixation（ unilateral group）, including 7 males and 4 females（ 5 cases of L（2-5）, 6 cases of L3-S1） with an average age of 47.6 years（ range： 31-64 years）. There were 14 cases of TLIF（ 1 case of L（1-4）, 5 cases of L（2-5）, 8 cases of L3-S1） with bilateral pedicle screw fixation（ bilateral group）, including 8 males and 6 females with an average age of 50.5 years（ range： 26-66 years）. Clinical effects were evaluated with Japanese Orthopaedic Association Scores（ JOA）. The operation time, blood loss, fusion rate, the starting time of postoperative independent turn over, incidence rate of complications, postoperative mobilization time and operative costs in 2 groups were compared. Results Preoperative JOA in the unilateral group was（ 8.55 ± 2.96）, while postoperatively（ 25.09 ± 8.92）. Preoperative JOA in the bilateral group was（ 8.79 ± 3.37）, while postoperatively（ 25.00 ± 7.49）. Operation time, blood loss, the starting time of independent postoperative turn over, postoperative mobilization time and operative costs in the unilateral group were（ 177.27 ± 30.48） min,（ 220.91 ± 34.46） ml,（ 1.73 ± 1.10） days,（ 9.45 ± 2.69） days,（ 65676.82 ± 2149.83） yuan, while the bilateral group（ 130.71 ± 40.02） min,（ 311.43 ± 57.45） ml,（ 2.43 ± 1.49） days,（ 9.29 ± 2.61） days,（ 95774.29 ± 2015.19） yuan. The fusion rate of the unilateral group and bilateral group were 90.9%（ 30/33） and 92.9%（ 39/42）. JOA differences in 2 groups showed statistical significance preoperatively and 1 year postoperatively（ P〈0.05）. There

关 键 词：椎管狭窄 脊柱融合术 腰椎 椎弓根钉 

分 类 号：R687.3[医药卫生—骨科学]