椎弓根螺钉内固定联合单轴内镜下椎间融合治疗腰椎退变性疾病  

Uniaxial endoscopic intervertebral fusion combined with pedicle screw fixation in treatment of lumbar degenerative diseases

作　　者：唐龙[1] 郑佳状[1] 汪凡栋 刘元彬 宋昭君[1] 张智[2] 王淼[1] 周永 刘会毅 陈宇[1] Tang Long;Zheng Jiazhuang;Wang Fandong;Liu Yuanbin;Song Zhaojun;Zhang Zhi;Wang Miao;Zhou Yong;Liu Huiyi;Chen Yu(Department of Spine Surgery,Suining Central Hospital,Chongqing Medical University,Suining 629000,Sichuan Province,China;Department of Orthopedics,Chengdu Fifth People’s Hospital,Chengdu 611130,Sichuan Province,China)

机构地区：[1]重庆医科大学附属遂宁市中心医院脊柱外科,四川省遂宁市629000 [2]成都市第五人民医院骨科,四川省成都市611130

出　　处：《中国组织工程研究》2024年第24期3873-3878,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省卫生健康委科研项目(20SYJS40),项目负责人:张智;遂宁市中心医院科研项目(2021y16),项目负责人:唐龙。

摘　　要：背景:随着脊柱微创外科技术在临床的迅猛发展及快速康复理念的加强,内镜下腰椎椎间融合技术近年来在临床逐渐兴起并得到广泛应用。目的:分析后路经皮椎弓根螺钉内固定联合单轴脊柱内镜下椎间融合治疗腰椎退变性疾病的早期临床疗效。方法:纳入2020年10月至2021年12月遂宁市中心医院收治的腰椎退行性疾病患者135例,其中男59例、女76例,年龄47-79岁,均接受单轴脊柱内镜下椎间融合联合后路经皮椎弓根螺钉内固定治疗。术前及术后1周、1个月、6个月及末次随访时,采用目测类比评分评估腰部和下肢疼痛情况,采用Oswestry功能障碍指数评估腰椎功能状况;术前及末次随访时,采用中华骨科学会脊柱学组腰背痛手术评分标准评估患者疼痛总体恢复情况,通过影像学检测评估腰椎生理曲度与椎间融合情况。结果与结论:①135例患者术后获得(17.8±3.0)个月随访,发生终板损伤1例,脑脊液漏1例,神经根损伤1例,椎间融合器下沉与移位各1例,慢性感染1例,椎弓根螺钉断裂1例,并发症发生率为5.2%;②与术前比较,135例患者术后各时间点的腰部及下肢目测类比评分、Oswestry功能障碍指数均明显降低(P<0.05);135例患者末次随访的中华骨科学会脊柱学组腰背痛手术评分明显优于术前(P<0.05);③末次随访时,135例患者的腰椎生理曲度与术前比较无明显变化(P>0.05),椎间融合率为95.8%;④结果显示,后路经皮椎弓根螺钉内固定联合单轴脊柱内镜下椎间融合治疗腰椎退变性疾病的早期临床效果满意,是一种安全性较高的脊柱微创手术方式。BACKGROUND:With the rapid development of minimally invasive spinal surgery and enhanced recovery after surgery,endoscopic intervertebral fusion techniques have gradually emerged and been widely used in clinical practice in recent years.OBJECTIVE:To analyze the early clinical efficacy of uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases.METHODS:135 patients with lumbar degenerative diseases treated by uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the Suining Central Hospital from October 2020 to December 2021 were enrolled in this study.There were 59 males and 76 females,aged 47-79 years.The lower limb and lumbar pain was evaluated by visual analog scale and lumbar function was assessed by Oswestry disability index before the operation,1 week,1,and 6 months after the operation,and at the end of follow-up.The overall pain recovery of patients was evaluated by the scoring criteria for low back pain surgery of Spine Group of Chinese Orthopedic Association and the lumbar physiological curvature and intervertebral fusion were evaluated on lumbar lateral X-ray preoperatively and at the end of follow-up.RESULTS AND CONCLUSION:(1)The 135 patients were followed up for(17.8±3.0)months after surgery.There was 1 case of endplate injury,1 case of cerebrospinal fluid leakage,1 case of nerve root injury,1 case of intervertebral cage subsidence and displacement,1 case of chronic infection,and 1 case of pedicle screw rupture.The complication rate was 5.2%.(2)The lumbar visual analog scale score and Oswestry disability index significantly decreased in the waist and lower limbs at various time points postoperatively compared with those preoperatively in 135 patients(P<0.05).The scoring criteria for low back pain surgery of the Spine Group of the Chinese Orthopedic Association were significantly better at the last follow-up than that preoperatively in 135 patien

关 键 词：单轴脊柱内镜 椎间融合术 经皮椎弓根螺钉 腰椎退变性疾病 腰椎椎间融合 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R681.5