棘突及椎板外缘联合定位法行腰椎椎弓根螺钉置入的准确性及安全性分析  

The accuracy and safety of lumbar pedicle screw placement reference spinous process and lamina rim

作　　者：王铁铸[1] 周宁[1] 闫箐辉 李士学[1] 裴世深[1] 王清和[1] WANG Tie-zhu;ZHOU Ning;YAN Qing-hui;LI Shi-xue;PEI Shi-shen;WANG Qing-he(Department of Spinal Surgery, the Fourth People′s Hospital of Hengshui, Hebei Province, Hengshui 053000, China)

机构地区：[1]河北省衡水市第四人民医院脊柱外科,河北衡水053000

出　　处：《河北医科大学学报》2020年第9期1039-1042,1057,共5页Journal of Hebei Medical University

基　　金：衡水市科技计划项目(15079)。

摘　　要：目的探讨腰椎棘突与椎板外缘联合定位法行椎弓根螺钉置入的准确性及安全性。方法选择腰椎管狭窄症患者82例,均行腰后路椎板减压植骨内固定术治疗,根据术中所采用的椎弓根钉置钉法分为观察组(43例)和对照组(39例)。观察组采用腰椎棘突与椎板外缘联合定位法置钉;对照组采用上关节突外缘垂线与横突平分线交点(Magerl法)。比较2组手术时间、术中出血量、术中透视次数、首次置钉准确率、螺钉与椎弓根皮质关系和并发症发生情况。结果所有患者均顺利完成手术。观察组切口长度长于对照组(P<0.05)。2组手术时间、术中出血量、术中透视次数、进钉点选取准确数差异均无统计学意义(P>0.05)。术后1个月2组VAS评分均低于术后1周(P<0.05);2组术后1周和术后1个月VAS评分差异均无统计学意义(P>0.05)。观察组螺钉与椎弓根皮质的关系优于对照组(P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论与Magerl置钉法相比,腰椎棘突与椎板外缘联合定位置钉法可获得相同的置钉准确率,但术后椎弓根与螺钉包容关系更好,为提高椎弓根螺钉的有效置入率提供一种全新的方案及选择。Objective To investigate the accuracy and safety of lumbar pedicle screw placement reference the spine process and the vertebral rim.Methods Eighty-two patients with lumbar spinal stenosis were enrolled and treated with posterior lumbar interbody fusion.According to the pedicle screw placement method,patients were divided into observation group(43 cases)and control group(39 cases).The pedicle screw was placed reference to the spinous process and the vertebral rim in observation group,and it was inserted according to the Magerl method in control group.The operative time,intraoperative blood loss,incision length,intraoperative fluoroscopy times,the accuracy of the nail placement,the relationship between the screw and the pedicle cortex,and the complications were recorded and compared.Results All patients were been operated successfully.The incision length in observation group was significantly longer than that in control group(P<0.05).There was no significant difference in operative time,intraoperative blood loss,fluoroscopy times,and the accuracy of nail placement between two groups(P>0.05).The VAS score at one month after surgery was significantly lower than the figure at one week after surgery(P<0.05).There was no significant difference between two groups at one week and one month after surgery(P>0.05).The relationship between screw and pedicle cortex in observation group was better than that in control group(P<0.05).There was no significant difference in the occurrence of complications between two groups(P>0.05).Conclusion Compared with the Magerl method,the new nailing method can obtain the same accuracy of nail placement,but the relationship between the screw and the pedicle cortex is better.It provided a new solution and choice for the placement of pedicle screws.

关 键 词：椎管狭窄 椎弓根螺钉 定位标记 

分 类 号：R681.57[医药卫生—骨科学]