胸腰椎后外侧钉棒系统前后一体固定技术治疗胸腰椎疾病效果观察
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摘要
目的评价胸腰椎后外侧钉棒系统前后一体固定技术治疗胸腰椎疾病的临床效果。方法回顾性分析经胸腰椎后外侧钉棒系统前后一体固定技术治疗的60例胸腰椎疾病患者临床资料,其中胸、腰椎椎间盘突出症35例,脊柱外伤10例,脊柱肿瘤8例,脊柱结核7例;利用疼痛评分、影像学指标和神经功能评分等比较术前、术后和末次随访时患者治疗效果。结果 60例患者手术均顺利,全部患者均获随访,平均随访时间30个月;术后3d疼痛视觉模拟评分(visual analogue scale,VAS)[(3.50±1.00)分]较术前[(7.90±0.90)分]降低(P<0.05),伤椎Cobb角[(5.08±1.22)°]较术前[(29.12±3.01)°]减小(P<0.05),伤椎前缘、后缘压缩率[(9.67±2.89)%、(10.34±3.01)%]较术前[(55.75±4.99)%、(44.03±5.22)%]减少(P<0.05),椎管狭窄率[(10.14±2.69)%]较术前[(60.98±20.21)%]降低(P<0.05);术后3d与末次随访时VAS评分、Cobb角度数、以及椎管狭窄率比较差异均无统计学意义(P>0.05);2例术后脊髓神经功能无改善,其余患者均有1级或1级以上的恢复(P<0.05)。结论胸腰椎疾病经胸腰椎后外侧钉棒系统前后一体固定技术治疗后可减轻疼痛,影像学指标及神经功能改善。
Objective To evaluate the clinical effect of anterior-posterior fixation by posterolateral screw-rod system on thoracolumbar diseases.Methods The clinical data of 60 patients with thoracolumbar disorders receiving anteriorposterior fixation by posterolateral screw-rod system were retrospectively analyzed.The clinical effects were compared by observing the changes of visual analogue scale,imaging parameters and neurological function scores before surgery,after surgery and at the final follow-up.Results Sixty patients with thoracolumbar disease included 35 patients with thoracolumbar disc herniation,10 with spinal trauma,8 with spinal tumors and 7 with spinal tuberculosis.All patients were followed up with a mean follow-up of 30 months.The visual analogue scale score was significantly lower(3.50±1.00),the Cobb angle was significantly smaller((5.08±1.22)°),the compression rates at the leading and trailing edges were significantly lower((9.67±2.89)%,(10.34±3.01)%),and the compression spinal cord stenosis rate was significantly lower((10.14±2.69)%)than those before operation by day 3 after operation than those before operation((7.90±0.90,(29.12±3.01)°,(29.12±3.01)°,(55.75±4.99)%,(44.03±5.22)%,(60.98±20.21)%)(P<0.05).There were no significant differences in the visual analogue scale score,Cobb angle and spinal cord stenosis rate by day 3 after operation in comparison with those at the final follow-up(P>0.05).Except 2 patients with no improvement in neurological function,the other patients had grade 1 or greater recovery(P<0.05).Conclusion Anterior-posterior fixation by posterolateral screw-rod system could obviously reduce pain caused by thoracolumbar diseases,and the imaging parameters and neurological function are significantly improved.
Objective To evaluate the clinical effect of anterior-posterior fixation by posterolateral screw-rod system on thoracolumbar diseases.Methods The clinical data of 60 patients with thoracolumbar disorders receiving anteriorposterior fixation by posterolateral screw-rod system were retrospectively analyzed.The clinical effects were compared by observing the changes of visual analogue scale,imaging parameters and neurological function scores before surgery,after surgery and at the final follow-up.Results Sixty patients with thoracolumbar disease included 35 patients with thoracolumbar disc herniation,10 with spinal trauma,8 with spinal tumors and 7 with spinal tuberculosis.All patients were followed up with a mean follow-up of 30 months.The visual analogue scale score was significantly lower(3.50±1.00),the Cobb angle was significantly smaller((5.08±1.22)°),the compression rates at the leading and trailing edges were significantly lower((9.67±2.89)%,(10.34±3.01)%),and the compression spinal cord stenosis rate was significantly lower((10.14±2.69)%)than those before operation by day 3 after operation than those before operation((7.90±0.90,(29.12±3.01)°,(29.12±3.01)°,(55.75±4.99)%,(44.03±5.22)%,(60.98±20.21)%)(P<0.05).There were no significant differences in the visual analogue scale score,Cobb angle and spinal cord stenosis rate by day 3 after operation in comparison with those at the final follow-up(P>0.05).Except 2 patients with no improvement in neurological function,the other patients had grade 1 or greater recovery(P<0.05).Conclusion Anterior-posterior fixation by posterolateral screw-rod system could obviously reduce pain caused by thoracolumbar diseases,and the imaging parameters and neurological function are significantly improved.
引文
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[5]杨彬,王小刚,王亚寒,等.附加伤椎经椎弓根螺钉内固定术结合术中CT在合并神经症状的胸腰椎骨折手术中的应用[J].中华实用诊断与治疗杂志,2018,32(5):483-485.
[6]杨常用,徐志刚,刘建标.胸腰椎骨折闭合复位经皮椎弓根钉内固定及椎体植骨术的临床治疗效果研究[J].实用骨科杂志,2016,22(7):623-626.
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[9]许科峰,汪建良,郭峰,等.后外侧减压、椎间融合结合钉棒系统前后一体固定技术治疗胸腰段椎间盘突出症[J].颈腰痛杂志,2013,34(5):377-380.
[10]卢绪,汪建良,许科峰,等.经后外侧入路前后一体椎弓根钉棒系统内固定治疗胸腰椎骨折合并脊髓损伤70例[J].中国骨与关节损伤杂志,2016,31(11):1178-1180.
[11]梁雄飞,陈书连,赵小兵,等.单侧后外侧入路椎体成形术治疗腰椎骨质疏松性压缩骨折临床分析[J].中华实用诊断与治疗杂志,2016,30(5):492-494.
[12]汪建良,许科峰.脊柱胸腰段钉棒系统后外侧前后一体内固定的有限元分析[J].中国组织工程研究,2014,18(40):6531-6535.
[13]严小虎,杨红胜,曹宗锐,等.应用“漏斗法”和“球探技术”椎弓根植钉治疗上胸椎骨折临床效果分析[J].中华实用诊断与治疗杂志,2016,30(8):786-788.
[14]孙宜保,杨勇.单切口椎旁肌入路经伤椎置钉治疗25例胸腰椎压缩骨折疗效分析[J].医药论坛杂志,2014,35(5):103-104.
[15]陈晨.退变性脊柱侧凸患者发生骨质疏松性椎体压缩骨折的危险因素分析[J].中国实用医刊,2017,44(7):52-55.
[2] VERLAAN J J,DIEKERHOF C H,BUSKENS E,et al.Surgical treatment of traumatic fractures of the thoracic and lumbar spine:a systematic review of the literature on techniques,complications,and outcome[J].Spine,2004,29(7):803-814.
[3] ETCHEPARE F,ROZENBERG S,MIRAULT T,et al.Back problems in Parkinson's disease:an underestimated problem[J].Joint Bone Spine,2006,73(3):298-302.
[4] FRANKEL H L,HANCOCK D O,HYSLOP G,et al.The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia[J].Paraplegia,1969,7(3):179-192.
[5]杨彬,王小刚,王亚寒,等.附加伤椎经椎弓根螺钉内固定术结合术中CT在合并神经症状的胸腰椎骨折手术中的应用[J].中华实用诊断与治疗杂志,2018,32(5):483-485.
[6]杨常用,徐志刚,刘建标.胸腰椎骨折闭合复位经皮椎弓根钉内固定及椎体植骨术的临床治疗效果研究[J].实用骨科杂志,2016,22(7):623-626.
[7] KOROVESSIS P,BAIKOUSIS A,ZACHARATOS S,et al.Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar(L2-L4)burst fractures[J].Spine,2006,31(8):859-868.
[8]MCDONOUGH P W,DAVIS R,TRIBUS C,et al.The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation[J].Spine,2004,29(17):1901-1908.
[9]许科峰,汪建良,郭峰,等.后外侧减压、椎间融合结合钉棒系统前后一体固定技术治疗胸腰段椎间盘突出症[J].颈腰痛杂志,2013,34(5):377-380.
[10]卢绪,汪建良,许科峰,等.经后外侧入路前后一体椎弓根钉棒系统内固定治疗胸腰椎骨折合并脊髓损伤70例[J].中国骨与关节损伤杂志,2016,31(11):1178-1180.
[11]梁雄飞,陈书连,赵小兵,等.单侧后外侧入路椎体成形术治疗腰椎骨质疏松性压缩骨折临床分析[J].中华实用诊断与治疗杂志,2016,30(5):492-494.
[12]汪建良,许科峰.脊柱胸腰段钉棒系统后外侧前后一体内固定的有限元分析[J].中国组织工程研究,2014,18(40):6531-6535.
[13]严小虎,杨红胜,曹宗锐,等.应用“漏斗法”和“球探技术”椎弓根植钉治疗上胸椎骨折临床效果分析[J].中华实用诊断与治疗杂志,2016,30(8):786-788.
[14]孙宜保,杨勇.单切口椎旁肌入路经伤椎置钉治疗25例胸腰椎压缩骨折疗效分析[J].医药论坛杂志,2014,35(5):103-104.
[15]陈晨.退变性脊柱侧凸患者发生骨质疏松性椎体压缩骨折的危险因素分析[J].中国实用医刊,2017,44(7):52-55.