单侧椎弓根螺钉固定结合肾形融合器椎体间融合治疗退行性腰椎疾病
摘要
目的观察采用单侧椎弓根钉固定结合肾形融合器椎体间融合治疗2节段以下退行性腰椎疾病的疗效。方法回顾性分析2014年1月至2015年6月期间采用单侧椎弓根钉固定结合肾形融合器椎体间融合术治疗退行性腰椎疾病26例,其中男性12例,女性14例,平均年龄(48.1±12.5)岁。L_(3～4)节段1例,L_(4～5)节段8例,L_5S_1节段12例,L_4～S_1节段5例。采用日本骨科协会评分(Japanese orthopedic association score,JOA)评估术后疗效,回顾手术时间、失血量、并发症、住院时间。采用CT评估椎间融合的融合率。结果本组所有患者均获随访,随访时间18～24个月,平均20.3个月。术前和术后JOA评分差异有统计学意义(P<0.05),改善率为79.07%。平均手术时间90 min;术中平均出血量250 mL;平均住院时间为8.5 d。随访结束时椎体间融合率为100%。至随访中末时,无断钉现象发生。结论对2个节段以下的退行性腰椎疾病采用单侧椎弓根螺钉固定结合肾形融合器椎体间融合可以获得满意的疗效。
引文
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[3]Goel VK,Lim TH,Gwon J,et al.Effects of rigidity of an internal fixation device:A comprehensive biomechanical investigation[J].Spine,1991,16(3Suppl):S155-161.
[4]Kabins MB,Weinstein JN,Spratt KF,et al.Isolated L4~5fusions using the variable screw placement system:Unilateral versus bilateral[J].J Spinal Disord,1992,5(1):39-49.
[5]Suk KS,Lee HM,Kim NH,et al.Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion[J].Spine(Phila Pa 1976),2000,25(14):1843-1847.
[6]陈志明,马华松,赵杰,等.腰椎单侧椎弓根螺钉固定的三维有限元分析[J].中国脊柱脊髓杂志,2010,20(8):684-688.
[7]Chen HH,Cheung HH,Wang WK,et al.Biomechanical analysis of unilateral fixation with interbody cages[J].Spine(Phila Pa 1976),2005,30(4):E92-96.
[8]Zhang K,Sun W,Zhao CQ,et al.Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders:aprospective randomised study[J].Int Orthop,2014,38(1):111-116.
[9]Mao L,Zhao J,Dai KR,et al.Bilateral decompression using a unilateral pedicle construct for lumbar stenosis[J].Int Orthop,2014,38(3):537-538.
[10]Xie Y,Ma H,Li H,et al.Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion[J].Orthopedics,2012,35(10):e1517-1523.
[11]谭健,李平元,欧军,等.单侧椎弓根螺钉固定联合椎间融合术治疗腰椎间盘突出症[J].实用骨科杂志,2015,21(1):5-8.
[12]张帅,徐皓,尹承慧,等.可扩张通道单侧椎弓根内固定在腰椎融合术中的临床应用[J].实用骨科杂志,2016,22(9):773-776.
[13]Yuan C,Chen K,Zhang H,et al.Unilateral versus bilateral pedicle screw fixation in lumbar interbody fusion:a meta-analysis of complication and fusion rate[J].Clin Neurol Neurosurg,2014(117):28-32.
[14]王晓峰,欧云生,蒋电明,等.肾型n-HA/PA66腰椎间融合器在经椎间孔腰椎椎体间融合术中的有限元分析[J].中国临床解剖学杂志,2014,32(1):67-71.
[15]Fukuta S,Miyamoto K,Hosoe H,et al.Kidney-type intervertebral spacers should be located anteriorly in cantilever transforaminal lumbar interbody fusion:analyses of risk factors for spacer subsidence for a minimum of 2years[J].J Spinal Disord Tech,2011,24(3):189-195.
[16]Le TV,Baaj AA,Dakwar E,et al.Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion[J].Spine,2012,37(14):1268-1273.
[17]Evans JH.Biomechanics of lumbar fusion[J].Clin Orthop Relat Res,1985(193):38-46.