皮质骨轨迹螺钉在腰椎后路融合术后邻椎病中的应用及疗效分析  

Effects of cortical bone trajectory screw in adjacent-segment disease after posterior lumbar interbody fusion

作　　者：李杰[1] 陈意磊[2] 陈斌辉[1] 干开丰 刘军辉[2] 单治[2] 朱刃 范顺武[2] 赵凤东[2] Jie Li;Yilei Chen;Binhui Chen;Kaifeng Gan;Junhui Liu;Zhi Shan;Ren Zhu;Shuwu Fan;Fengdong Zhao(Department of Orthopaedic Surgery,Ningbo Medical Center Lihuili Hospital,Ningbo 315000,China;Department of Orthopaedic Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province,Hangzhou 310016,China;Department of Orthopedics,Yiwu Chouzhou Hospital,Yiwu 322000,China)

机构地区：[1]宁波市医疗中心李惠利医院骨科,宁波315000 [2]浙江大学医学院附属邵逸夫医院骨科,浙江省骨骼肌肉退变与再生修复转化研究重点实验室,杭州310016 [3]义乌稠州医院骨科,义乌322000

出　　处：《中华医学杂志》2021年第45期3724-3729,共6页National Medical Journal of China

基　　金：宁波市自然基金(202003N4279);金华市公益类科技计划(2018-4-150);义乌市一般科研计划(18-3-42)。

摘　　要：目的探讨皮质骨轨迹(CBT)螺钉固定结合后路中线腰椎融合术(MIDLF)在腰椎后路融合术后邻椎病中应用的临床疗效。方法回顾性分析2013年5月至2019年8月浙江大学邵逸夫医院骨科应用CBT结合MIDLF技术治疗的16例MIDLF术后邻椎病翻修手术患者的资料,其中男9例,女7例,年龄(68±6)岁。手术原因:神经根痛4例、间歇性跛行10例、顽固性腰痛2例;初次手术融合的节段数:1节段11例,2节段5例,与初次手术间隔时间为(7.5±2.0)年。翻修手术节段:1例L2/3,6例L3/4,7例L4/5,2例L5/S1。患者术前均摄胸腰椎正侧位X线片,并行CT及MRI扫描检查。记录手术时间、术中出血、手术并发症等。应用视觉模拟评分(VAS)记录术前、各次随访时腰腿痛情况,应用Oswestry功能障碍指数(ODI)问卷表,评估患者手术前后的功能改善情况。结果16例手术均顺利完成,手术时间(170±30)min(120~240 min);术中出血量(220±45)ml(100~280 ml)。1例峡部轻微劈裂,微调进钉点后顺利置入螺钉,1例术中脑脊液渗漏,术后予去枕平卧、加强抗感染对症处理后好转。随访时间(19.5±1.3)个月。术前VAS腰痛评分(2.9±1.7)分,末次随访为(1.8±0.5)分,差异有统计学意义(P<0.01);术前VAS腿痛评分(5.9±1.5)分,末次随访为(1.5±0.4)分,差异有统计学意义(P<0.01);术前ODI评分(34.5±3.2)分,末次随访(12.6±4.2)分,差异有统计学意义(P<0.01)。结论CBT内固定技术结合MIDLF用于腰椎后路融合术后邻椎病,具有损伤小、操作方便的优点,手术效果良好,可作为邻椎病翻修手术方案一种选择。Objective To investigate the effect of the cortical bone trajectory(CBT)screw fixation combined with midline lumbar fusion(MIDLF)for adjacent spondylopathy after posterior lumbar interbody fusion.Methods A retrospective analysis was conducted in 16 patients,including 9 males and 7 females,with a mean age of(68±6)years,who underwent revision surgery for adjacent spondylopathy after posterior lumbar fusion surgery using CBT combined with MIDLF technology in Sir Run Run Shaw Hospital,Zhejiang University from May 2013 to August 2019.The reasons for revision were radiculalgia in 4 cases,intermittent claudication in 10 cases and protrusive dissociate in 2 cases.Eleven cases had 1 segment fused in the first operation,while the other 5 cases received fusion in 2 segments.The average interval time between the first operation and the revision operation was(7.5±2.0)years.For the levels underwent revision,1 case was L2/3,6 cases were L3/4,7 cases were L4/5 and 2 cases were L5/S1.Before the operation,all the patients took X-rays scans of the thoracic and lumbar spine.CT and MRI scans were also performed.The operation time,intraoperative bleeding,surgical complications,visual analog scale(VAS)of low back and leg pain before the operation and at each follow-up were all recorded.Oswestry disability index(ODI)questionnaire was used to evaluate the functional improvement of patients after the operation.Results All operations were completed successfully.The operation time was 120-240(170±30)mins,intraoperative bleeding was 100-280(220±45)ml.One case had a slight split in the isthmus,and the screw was inserted smoothly after adjusting the insertion point.In one case,the cerebrospinal fluid leaked during the operation and was successfully treated with conservative methods including no pillow supine treatment and strengthened anti-infection.The average follow-up time was of(19.5±1.3)months.The VAS of low back pain was 2.9±1.7 before the operation and it was 1.8±0.5 at the last follow-up,and the difference was statistically sign

关 键 词：脊柱融合术 皮质骨轨迹螺钉 邻椎病 腰椎后路融合手术 随访研究 

分 类 号：R687.3[医药卫生—骨科学]