[1]王海峰,曾忠友,金辉.双侧皮质骨轨迹椎弓根螺钉内固定联合椎间融合治疗腰椎退行性病变[J].中医正骨,2020,32(05):52-56.
点击复制

双侧皮质骨轨迹椎弓根螺钉内固定联合椎间融合治疗腰椎退行性病变()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年05期
页码:
52-56
栏目:
临床报道
出版日期:
2020-05-20

文章信息/Info

作者:
王海峰曾忠友金辉
(中国人民武装警察部队海警总队医院,浙江 嘉兴 314033)
关键词:
腰椎 椎间盘移位 脊椎滑脱 椎管狭窄 脊柱融合术
摘要:
目的:探讨双侧皮质骨轨迹(cortical bone trajectory,CBT)椎弓根螺钉内固定联合椎间融合治疗腰椎退行性病变的临床疗效和安全性。方法:2014年6月至2016年12月收治92例腰椎退行性病变患者。男56例,女36例。年龄39~72岁,中位数53岁。腰椎间盘突出症59例,腰椎椎管狭窄症19例,腰椎退行性滑脱(MeyerdingⅠ度)14例。均为单节段病变,其中L3~426例、L4~542例、L5S124例。均采用双侧CBT椎弓根螺钉内固定联合椎间融合治疗。采用视觉模拟量表(visual analogue scale,VAS)评定患者的腰痛程度,采用日本骨科学会腰背痛调查问卷(Japanese Orthopedic Association back pain evaluation questionnaire,JOABPEQ)评定总体疗效。测量病变节段椎间隙高度、腰椎冠状位和矢状位Cobb角,并评价CBT螺钉的位置及椎间融合情况。观察治疗及随访期间并发症的发生情况。结果:所有患者的手术均顺利完成,且均获得12个月以上随访。手术时间65~130 min,中位数85 min。术中出血量140~420 mL,中位数270 mL; 所有患者均未输血; 术后引流量110~250 mL,中位数160 mL。1例患者术中发生硬脊膜损伤并脑脊液漏,由于硬脊膜囊破裂口较小,术中以明胶海绵填压硬脊膜囊破裂处,术后保持头低脚高位,未出现脑脊液漏及神经损伤症状; 2例患者发生终板损伤,术后绝对卧床2周并且佩戴胸腰支具2个月,随访X线片显示融合器部分嵌入椎体内。切口均甲级愈合。8例8个节段的椎间融合器发生沉降。未发生椎间隙感染、神经损伤、螺钉松动及断裂、椎间融合器移位、邻近节段退变等并发症。86例患者的362枚CBT螺钉位置为Ⅰ度; 6例患者的6枚CBT螺钉位置为Ⅱ度,均未出现神经根损伤症状,未调整螺钉位置。至末次随访时,8例椎间融合器内骨质稀疏、可见部分透亮线,不能明确椎间是否融合,其余84例均获得椎间融合。术前、术后6 d及末次随访时病变节段椎间隙高度分别为(9.6±1.5)mm、(11.5±1.4)mm、(11.1±1.3)mm; 术前及末次随访时的腰椎冠状面Cobb角分别为3.24°±0.89°、1.21°±1.15°; 术前及末次随访时的腰椎矢状面Cobb角分别为42.80°±8.17°、50.20°±7.47°。术前、术后6 d及末次随访时的腰部疼痛VAS评分分别为(6.2±0.5)分、(2.2±0.6)分、(1.2±0.6)分; 术前、术后6 d及末次随访时的JOABPEQ评分分别为(12.13±1.76)分、(24.30±1.56)分、(25.30±1.66)分。结论:双侧CBT椎弓根螺钉内固定联合椎间融合治疗腰椎退行性病变,可有效减轻患者的腰部疼痛症状、改善腰部功能,总体疗效较好,安全性较高。

参考文献/References:

[1] SANFORD H D,DONALD L M.Complications of lumbar spinal fusion with transpedicular instrumentation[J].Spine(Phila Pa 1976),1992,17(Supplement):S184-S189.
[2] STEPHEN I E,BARTON L S,DREYZIN V.Complications associated with the technique of pedicle screw fixation a selected survey of ABS members[J].Spine(Phila Pa 1976),1993,18(15):2231-2239.
[3] SANTONI B G,HYNES R A,MCGILVRAY K C,et al.Cortical bone trajectory for lumbar pedicle screws[J].Spine J,2009,9(5):366-373.
[4] DANIEL A B,ALPESH A P,LULLO B,et al.Effect of physiological loads on cortical and traditional pedicle screw fixation[J].Spine(Phila Pa 1976),2014,39(22):E1297-E1302.
[5] UENO M,IMURA T,INOUE G,et al.Posterior corrective fusion using a double-trajectory technique(cortical bone trajectory combined with traditional trajectory)for degenerative lumbar scoliosis with osteoporosis[J].J Neurosurg Spine,2013,19(5):600-607.
[6] DAVIES J.Measurement of pain[J].Surg Clin North Am,2009,10(2):231-252.
[7] FUKUI M,CHIBA K,KAWAKAMI M,et al.Japanese orthopaedic association back pain evaluation questionnaire.part 2.verification of its reliability:the subcommittee on low back pain and cervical myelopathy evaluation of the clinical outcome committee of the Japanese orthopaedic association[J].J Orthop Sci,2007,12(6):526-532.
[8] XU R,EBRAHEIM N A,OU Y,et al.Anatomy considerations of pedicle screw placement in the thoracis spine:Roy-Camille technique versus open-lamina technique[J].Spine(Phila Pa 1976),1998,23(9):1065-1068.
[9] SUK S I,LEE C K,KIM W J,et al.Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis[J].Spine(Phila Pa 1976),1997,22(2):210-219.
[10] HARIRI O R,KASHYAP S,TAKAYANAGI A,et al.Posterior-only stabilization for traumatic thoracolumbar burst fractures[J].Cureus,2018,10(3):e2296.
[11] ALBERT P W,SHIH P,TIMOTHY R S,et al.Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy,discectomy,or laminectomy[J].World Neurosurg,2014,81(3/4):634-640.
[12] DENNIS J R,JECK D,BRENNAN J,et al.Clinical outcomes and complications associated with pedicle screw fixation—augmented lumbar interbody fusion[J].J Neurosurg Spine,2004,1(3):261-266.
[13] SMITS A J,POLACK M,DEUNK J,et al.Combined anteroposterior fixation using a titanium cage versus solely posterior fixation for traumatic thoracolumbar fractures:a systematic review and meta-analysis[J].J Craniovertebr Junction Spine,2017,8(3):168-178.
[14] XING D,CHEN Y,MA J X,et al.A methodological systematic review of early versus late stabilization of thoracolumbar spine fractures[J].Eur Spine J,2013,22(10):2157-2166.

相似文献/References:

[1]吴青坡,孙国绍,王林杰.后路椎管减压联合腰椎椎弓根钉动态稳定装置内固定 治疗单节段腰椎退行性疾病[J].中医正骨,2015,27(10):42.
[2]李林军.应用膨胀式椎弓根螺钉内固定治疗合并骨质疏松的 胸腰椎退行性疾病[J].中医正骨,2015,27(08):49.
[3]孙广江,崔海舰.络病理论指导下应用独活寄生汤加减治疗腰椎间盘突出症[J].中医正骨,2015,27(12):37.
 SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(独活寄生汤加减)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):37.
[4]陈冠军,陈扬,庄汝杰.可灌注骨水泥椎弓根螺钉系统 在老年腰椎疾患手术中的应用[J].中医正骨,2015,27(02):40.
[5]万宏波,马海燕,蒋云霞,等.口服益气化瘀汤联合功能锻炼治疗腰椎退行性疾病 术后残留腰腿痛的临床研究[J].中医正骨,2015,27(06):1.
 WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益气化瘀汤)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):1.
[6]王世龙.腰椎椎管内外痛风石1例[J].中医正骨,2012,24(02):69.
[7]秦杰,李振宇.三法十式手法配合中药腰痹汤治疗腰椎间盘突出症[J].中医正骨,2011,23(02):71.
[8]颜 峰.椎间融合术配合中药外敷治疗退行性腰椎滑脱症[J].中医正骨,2016,28(01):38.
[9]喻秋萍,唐萌芽,王峥峰,等.身痛逐瘀汤治疗腰椎间盘突出症的系统评价[J].中医正骨,2016,28(06):24.
 YU Qiuping,TANG Mengya,WANG Zhengfeng,et al.Efficacy of Shentong Zhuyu Tang(身痛逐瘀汤)for treatment of lumbar disc herniation:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):24.
[10]董永强,何鑫东,张伟伟,等.经皮椎间孔镜髓核摘除术联合McKenzie疗法治疗腰椎间盘突出症的临床研究[J].中医正骨,2016,28(07):38.
 DONG Yongqiang,HE Xindong,ZHANG Weiwei,et al.Observation on the curative effect of fire-needle therapy for treatment of supraspinal and interspinal ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):38.
[11]刘彦璐,林耐球,李绍旦,等.正骨手法结合中药外敷治疗腰椎间盘突出症[J].中医正骨,2015,27(02):26.
[12]邵礼晖,潘浩.Coflex棘突间动态稳定系统治疗腰椎退变性疾病40例[J].中医正骨,2015,27(02):37.
[13]郭新军,朱卉敏,王衡,等.一次性纤维环缝合器在腰椎间盘突出症髓核摘除术中的应用[J].中医正骨,2015,27(03):59.
[14]林斌,黎秋生,何勇,等.椎弓根螺钉单侧固定与双侧固定治疗腰椎间盘突出症 对邻近节段退变的影响[J].中医正骨,2015,27(01):16.
 LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):16.
[15]贾龙,张华.“治未病”思想指导下腰椎间盘突出症的辨证防治[J].中医正骨,2017,29(01):36.
[16]聂富祥,贺海怿,朱文辉,等.一次性可扩张通道下微创经椎间孔入路腰椎间融合术治疗单节段腰椎退行性疾病[J].中医正骨,2017,29(05):34.
[17]宋仁谦,周英杰,赵刚.经皮可灌注骨水泥椎弓根螺钉固定治疗合并严重骨质疏松症的腰椎退行性疾病[J].中医正骨,2017,29(05):37.
[18]张史飞,任绍东,屠永刚,等.椎弓根螺钉双皮质固定治疗合并骨质疏松的腰椎不稳症[J].中医正骨,2017,29(09):73.
[19]邓罗义,孙红,宁旭.神经根沉降征及其在腰椎退行性疾病诊断中的应用价值[J].中医正骨,2018,30(08):50.
[20]李智斐,李嘉琅,张翼升,等.医用臭氧治疗腰椎间盘突出症的作用机制及应用进展[J].中医正骨,2018,30(10):59.

备注/Memo

备注/Memo:
(收稿日期:2019-09-24 本文编辑:李晓乐)基金项目:嘉兴市科技计划项目(2017AY33061)通讯作者:金辉 E-mail:huijin75@163.com
更新日期/Last Update: 2020-08-15