通道下联合固定并椎间不同融合器植骨治疗腰椎病变的对比研究
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作者Author单位AddressE-Mail
曾忠友* zengzhongyou 武警海警总队医院 Hospital of Coast Guard Corps of Armed Police Forces zjzengzy@126.com 
期刊信息:《中国骨伤》年,第卷,第期,第-页
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中文摘要:目的 观察并对比肌间隙入路通道下单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并分别采用单枚普通融合器、双枚普通融合器或香蕉型融合器进行椎间植骨治疗腰椎单节段病变的临床结果 方法 自2014年6月~2016年12月收治腰椎单节段病变123例,其中男44例,女79例; 年龄22~60岁,平均(48.11±6.12)岁;病史时间6~84个月,平均(31.83±11.25)个月。疾病类型:腰椎间盘退变65例,腰椎管狭窄症30例、腰椎退行性滑脱Ⅰ°21例、巨大型腰椎间盘突出症7例。病变部位:腰3/45例、腰4/5101例,腰5骶117例。按入院顺序编号分别行单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并单枚普通融合器椎间植骨,或双枚普通融合器椎间植骨,或香蕉型融合器椎间植骨治疗,观察并对比三组病例的临床结果、影像结果和并发症情况。结果 在切口长度、手术时间、术中出血量、术后切口引流液量和术后72h腰部切口VAS评分方面,三组对比差异均无统计学意义(P>0.05)。所有病例均获得12~36个月、平均23.7个月的随访。三组术后椎间隙高度均有明显改善,与术前对比差异均有统计学意义(P<0.05),最后随访时三组病例椎间隙高度有程度不等的丢失,其中单枚融合器组>香蕉型融合器组>双枚融合器组。三组病例在腰椎冠状面和矢状面Cobb角变化方面,最后随访时与术前相比差异均有统计学意义(P<0.05)。随访过程中出现融合器沉降42例,其中单枚融合器组26例,发生率63%;双枚融合器组5例,发生率12%:香蕉型融合器组11例,发生率28%,三组对比有统计学差异。三组病例12个月椎间融合情况为:单枚融合器组融合率83%,双枚融合器组为95%,香蕉型融合器组为90%,三组间对比:双枚融合器组和香蕉型融合器组的椎间融合率优于单枚融合器组。未观察到固定部位邻近节段的明显退变。JOA评分方面:三组最后随访时的JOA评分与术前对比差异均有统计学意义(P<0.05),说明腰痛和腰椎功能均获得较好的改善;而三组间比较差异均无统计学意义(P>0.05)。并发症情况:单枚融合器组发生率10%,双枚融合器组为9%, 香蕉融合器组为10.0%;并发症三组对比差异无统计学意义。结论 肌间隙入路通道下单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并分别采用单枚普通融合器、双枚普通融合器或香蕉型融合器进行椎间植骨治疗腰椎单节段病变,虽然不同融合器的使用并没有增加固定的轴向强度,但通过增加接触面积,提高了局部的稳定性,促进了植骨融合的速度和质量,减少了融合器沉降的发生和椎间隙高度的丢失。因此,通过一侧椎管减压、椎间隙植入两枚融合器,对于采用单侧椎弓根螺钉联合对侧椎板关节突螺钉固定的方式具有积极的临床意义,而且没有增加手术并发症。
【关键词】腰椎  内固定  椎间融合  临床结果  并发症
 
Comparison of different cages through intermuscular approach for lumbar diseases
ABSTRACT  Abstract: [Objective] To compare the clinical outcomes of single ordinary cage, double ordinary cages and banana type cage for treatment of lumbar diseases. [Methods] 123 patients with lower lumbar diseases who underwent unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages between June 2014 and December 2016 were retrospectively included in this study. These patients, 44 males and 79 females, ranging in age from 22 to 60 years, with a mean age of 48.11 years, suffered from lower lumbar lesions for 31.83 months on average (range 6 to 84 months). Among these patients, lumbar intervertebral disc degeneration was found in 65 patients, spinal canal stenosis in 30 patients, lumbar degenerative spondylolisthesis (Ⅰ°) in 21 patients and massive lumbar intervertebral disc herniation in 7 patients. These diseases occured at L3/4 in 5 patients, L4/5 in 101 patients and L5S1 in 17 patients. All the patients were divided into three groups, which were single ordinary cage group, double ordinary cages group and banana type cage group. The clinical results, complications and image datas were compared between the three groups. [Results] There were no significant differences in the incision length, operation time, intraoperative blood loss, postoperative incision drainage and VAS score of lumbar incision 72h after operation (P>0.05). All cases were followed up for 12 to 36 months, with an average of 23.7 months. The height of the intervertebral space was significantly improved in the three groups, and the difference was statistically significant (P<0.05). At the last follow-up, the height of the intervertebral space was lost in three groups, and the single ordinary cage group > banana type cage group > double ordinary cage group. There were significant differences in the Cobb angle of the coronal and sagittal planes between preoperative and last follow-up in the three groups (P<0.05). During the follow-up, 42 cases of cage settlement occurred, including 26 cases of single ordinary cage group with the incidence rate of 63%, 5 cases of double ordinary cage group with the incidence rate of 12%, 11 cases of banana type cage group with the incidence rate of 28%. Otherwise, there were statistical differences between the three groups. The single ordinary cage group fusion rate was 83%, double ordinary cage group was 95% and banana type cage group was 90%. No significant degeneration of adjacent segments of the fixation site was observed. There were significant differences in JOA scores at the last follow-up (P<0.05) compared to preoperation, but there was no significant difference between the three groups (P> 0.05). The incidence of complications was 10% in single ordinary cage group, 9% in the double ordinary cage group and 10% in the banana cage group, there was no significant difference between the three groups. [Conclusion] The unilateral pedicle screw combined with contralateral percutaneous translaminar facet screw fixation through intermuscular approach and single ordinary cage, double ordinary cages or banana type cage for treating lumbar diseases. Although the use of different area cages did not increase the fixed axial strength, but increase the contact area, improve the local stability, promote the speed and quality of bone graft fusion, and reduce the occurrence of cage subsidence and vertebral height loss. Therefore, the use of two cages has positive clinical significance for unilateral pedicle screw combined with contralateral percutaneous translaminar facet screw fixation, and does not increase surgical complications.
KEY WORDS  Lumbar spine  internal fixation  intervertebral fusion  clinical outcome  complications
 
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