腰椎两种不同椎间融合方式终板损伤的病例对照研究  

Case-control study on endplate injury of lumbar spine with two different intervertebral fusion methods

作　　者：曾忠友[1] 吴宏飞 范时洋 范顺武[2] 方向前[2] 赵兴[2] 宋永兴[1] 俞伟[1] 裴斐[1] 宋国浩[1] ZENG Zhong-you;WU Hong-fei;FAN Shi-yang;FAN Sun-wu;FANG Xiang-qian;ZHAO Xing;SONG Yong-xing;YU Wei;PEI Fei;SONG Guo-hao(不详;The Second Department of Orthopaedics,Hospital of Coast Guard General Corps of Armed Police Forces,Jiaxing 314000,Zhejiang,China)

机构地区：[1]武警部队骨科医学中心武警海警总队医院骨二科,浙江嘉兴314000 [2]浙江大学医学院附属邵逸夫医院骨科,浙江杭州310016

出　　处：《中国骨伤》2022年第10期933-942,共10页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2020KY968)。

摘　　要：目的:总结并比较肌间隙入路通道下经椎间孔椎间融合联合椎弓根螺钉固定方式与斜外侧椎间融合联合椎弓根螺钉固定方式治疗腰椎病变终板损伤的特点与临床结果。方法:回顾性分析2016年1月至2019年6月收治的213例腰椎病变患者,男73例,女140例;年龄24~81(54.9±10.5)岁;病程6~180(40.30±28.71)个月;腰椎间盘退行性病变35例,巨大型腰椎间盘突出症22例,椎间盘源性腰痛15例,炎症转归期原发性腰椎间隙炎9例,腰椎管狭窄症52例,腰椎退行性滑脱47例,腰椎椎弓峡部裂伴或不伴椎体滑脱33例;单节段191例(L_(2,3)5例、L_(3,4)24例、L_(4,5)162例),双节段22例(L_(2,3)和L_(3,4)3例、L_(3,4)和L_(4,5)19例)。采用后方肌间隙入路通道下双侧椎弓根螺钉固定并椎间融合术110例(后路融合组),斜外侧椎间融合联合后方肌间隙入路通道下双侧椎弓根螺钉固定术103例(斜外侧融合组)。观察两组患者终板损伤的发生特点,并比较两组患者的临床和影像结果及并发症情况。结果:后路融合组发生终板损伤8例9个节段,发生率7.27%(8/110),男1例,女7例,年龄(63.22±3.51)岁;8例中术前存在骨量减少或骨质疏松7例;使用香蕉型融合器5例,解剖型融合器3例;发生于椎体上终板3个节段,椎体下终板6个节段。斜外侧融合组发生终板损伤21例24个节段,发生率20.39%(21/103),男4例,女17例,年龄(62.50±5.02)岁;21例中术前存在骨量减少或骨质疏松16例;使用融合器偏大(指融合器高度)5例,终板解剖形态异常4例,髂嵴过高3例;发生于椎体上终板20个节段,椎体下终板4个节段;21例终板损伤中合并椎体骨折2例。后路融合组终板损伤发生率低于斜外侧融合组。两组患者均未发生切口感染,随访时间12~48个月,中位数12个月。随访中后路融合组出现融合器沉降22例,斜外侧融合组43例,两组各发生1例融合器移位,均无内固定松动、移位或断裂。斜外侧融合组并发�Objective:To summarize and compare the endplate injury occurrence characteristics and clinical results of transforaminal intervertebral fusion combined with pedicle screw fixation through intermuscular approach and oblique lateral intervertebral fusion combined with pedicle screw fixation in the treatment of lumbar disease.Methods:A retrospective analysis of 213 cases of lumbar disease admitted from January 2016 to June 2019,including 73 males and 140 females.The age ranged from 24 to 81 years old,with an average of(54.9±10.5)years old.The courses of disease ranged from 6 to 180 months,with an average of(40.30±28.71)months.There were 35 cases of degenerative lumbar intervertebral disc disease,22 cases of giant lumbar disc herniation,15 cases of discogenic low back pain,9 cases of primary lumbar intervertebral inflammation at the turn of inflammation,52 cases of lumbar spinal stenosis,47 cases of lumbar degenerative spondylolisthesis,33 cases of lumbar spondylolysis with or without spondylolisthesis.There were 191 cases of single-segment lesions,including 5 cases on L_(2,3),24 cases on L_(3,4),162 cases on L_(4,5).And there were 22 cases of two-segment lesions,including 3 cases on L_(2,3)and L_(3,4),and 19 cases on L_(3,4)and L_(4,5).One hundred and ten cases were taken by bilateral pedicle screw fixation and interbody fusion under the posterior muscle space approach(abbreviated as posterior fusion group),and 103 cases were taken by oblique lateral interbody fusion combined with bilateral pedicle screw fixation under the posterior muscle space approach(oblique lateral fusion group).Observed the characteristics of endplate injury in the two groups,and compared the clinical and imaging results and complications of the two groups.Results:There were 8 cases of endplate injury occurred in 9 segments in the posterior fusion group.According to the number of cases,the incidence rate was 7.27%(8/110),1 case was male,7 cases were female,with an average age of(63.22±3.51)years old.Among the 8 cases,there were 7 cases of b

关 键 词：腰椎 脊柱融合术 手术后并发症 终板损伤 

分 类 号：R681.5[医药卫生—骨科学]