空心椎弓根螺钉置入结合小切口后路腰椎融合治疗腰椎间盘突出症

Hollow pedicle screw fixation with minimal access-posterior lumbar interbody fusion for lumbar disc herniation

背景:经皮椎弓根螺钉技术的优点在于可有效减少置钉操作对椎旁肌的过度损伤,有利于患者术后的腰背肌功能恢复,其微创技术操作可避免传统开放手术创伤大,出血多等缺陷。可折断U形长尾空心椎弓根螺钉为中空设计,撑开效果良好,内固定后应力强度、压缩时间、弯曲刚度和扭转力学性能均得到临床验证。目的:观察可折断U形长尾空心椎弓根螺钉系统置入结合小切口后路腰椎椎体间融合治疗单节段腰椎间盘突出症的临床效果。方法:纳入2012年1至12月间因腰椎间盘突出症接受可折断U形长尾空心椎弓根螺钉系统置入结合小切口后路腰椎椎体间融合治疗的患者30例。术后随访12个月,通过患者腰腿疼目测类比评分、Oswestry功能障碍指数以及影像学指标评估临床治疗效果。结果与结论:患者术前目测类比评分及Oswestry功能障碍指数分别为(7.3±0.7)分和71.4±7.1;术后第3天分别为(2.9±0.7)分和29.8±3.6,与术前相比差异有显著性意义;至术后12个月时,低水平目测类比评分及Oswestry功能障碍指数未发生显著改变。术后短时间随访发现,病例术后1年椎间融合良好,无内固定失败或感染等并发症发生。提示可折断U形长尾空心椎弓根螺钉系统置入结合小切口后路腰椎椎体间融合治疗腰椎间盘突出症的临床效果良好,椎间融合率高,手术并发症发生率低,创伤小。

BACKGROUND：The percutaneous pedicle screw technique effectively reduces the excessive injury of screw placement on paraspinal muscles, and promotes the recovery of the function of low back muscle after surgery. Minimal y invasive technique avoids some disadvantages such as large surgical trauma and more bleeding. Folding U-shaped hol ow pedicle screw has hol ow design and good distraction effect. After fixation, stress intensity, compression time, bending stiffness and torsional mechanical properties have been verified in the clinic. OBJECTIVE：To observe the clinical effect of folding U-shaped hol ow pedicle screw fixation combined with minimal access-posterior lumbar interbody fusion for single-level lumbar disc herniation. METHODS：Between January and December 2012, folding U-shaped hol ow pedicle screw fixation with minimal access-posterior lumbar interbody fusion was performed in 30 patients with lumbar disc herniation. The mean fol ow-up period was 12 months. Lumbago Visual Analog Scale, Oswestry Disability Index and imaging indicators were utilized to evaluate clinical therapeutic effects. RESULTS AND CONCLUSION：Preoperative Visual Analog Scale pain score and Oswestry Disability Index for al patients were 7.3±0.7 and 71.4±7.1, 2.9±0.7 and 29.8±3.6 at 3 days after surgery, showing significant differences. At 12 months, no significant difference in Visual Analog Scale pain score and Oswestry Disability Index was detected. Postoperative short-period fol ow-up demonstrated that al lumbar interbody fusion was achieved in one year. There was no complication such as implant failure or infection. These findings indicated that folding U-shaped hol ow pedicle screw fixation with minimal access-posterior lumbar interbody fusion for lumbar disc herniation showed good clinical therapeutic effects, high rate of interbody fusion and a low rate of complications and smal trauma.