应用经皮椎弓根螺钉技术治疗腰椎退行性疾病

Application of percutaneous pedicle screw fixation for lumbar degenerative disease

目的：评估在X线透视下经皮椎弓根螺钉微创内固定技术治疗腰椎退行性病变的安全性和准确性。方法回顾性分析首都医科大学宣武医院2012年3月至2013年10月采用X线透视下经皮椎弓根螺钉微创内固定技术，结合显微镜下微创经椎间孔入路椎间盘摘除、椎体间融合术（TLIF）治疗64例腰椎退行性疾病患者的临床资料，随访3个月或以上，统计术中出血量、住院时间、并发症、术前与术后采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）进行疗效评估，计算患者症状改善率；术后生活质量调查（SF-36）；术后复查X线及腰椎CT平扫及腰椎核磁，评估螺钉位置及融合率。结果手术平均时间（3.4±0.9）h，术中出血平均（193±100）ml，住院平均时间（7±2）d，并发症发生率7.8％（5/64）。随访3个月显示，VAS和ODI改变差异有统计学意义（P＜0.01）。临床症状改善显著，ODI改善率为50.8％，SF-36平均86.2％；64例患者共植入316颗螺钉，术后X线显示306颗螺钉位置良好，10颗螺钉位置可接受，无螺钉松动；螺钉植入成功率达100％，融合率达96％。结论X线透视下微创内固定技术完全可以获得准确、理想的螺钉植入位置，结合显微镜下微创TLIF治疗腰椎退行性疾病是安全、有效的方法。

Objective To evaluate the accuracy and safety of mini-invasive and percutaneous pedicle screw fixation with fluoroscopy for lumbar degenerative disease.Methods For this retrospective study, 64 cases of lumbar degenerative disease underwent mini-invasive transforaminal lumbar interbody fusion （ TLIF） under microscope plus percutaneous pedicle screw fixation with fluoroscopy of lumbar spine from March 2012 to October 2013.The parameters of operative duration , intraoperative blood loss volume , hospital stay and complications were recorded and analyzed.The clinical outcomes were assessed with visual analog scale （VAS）, Oswestry disability index （ODI） and Short Form Health Survey-36 （SF-36）.The relevant examinations included plain radiography , dynamic radiology and lumbar magnetic resonance imaging （MRI） and computed tomography （CT）.Results The mean estimated blood loss volume was （193 ±100） ml, mean length of hospital stay （7 ±2） days, mean operative duration （3.4 ±0.9） hours and an overall complication rate 7.8%.Significant differences existedin mean VAS score and ODI between pre-and post-operation （P＆lt;0.01）.During a mean follow-up of 3 months, the improvement rate of ODI was 50.8%and mean SF-36 86.2%.A total of 316 screws were implanted into 64 patients.Among them, 306 were well-positioned and 10 fairly.The success rate of screw implantation was 100%.And solid fusion was achieved in 64 patients （96%）.Conclusion Mini-invasive and percutaneous pedicle screw fixation with fluoroscopy for lumbar degenerative disease is both efficacious and safe.And it may be combined with TLIF technique under microscope.