腰椎结核后路微创内固定软组织保护叶片的设计与应用

Use of a new-designed blade device for soft-tissue protection in pedicle screw fixation for lumbar tuberculosis

[目的]设计一种腰椎结核后路手术软组织保护叶片,并评估其在辅助完成腰椎结核后路微创内固定应用价值。[方法]2013年12月~2015年3月采用自制软组织保护叶片辅助经皮置入椎弓根螺钉固定治疗19例腰椎结核患者,男11例,女8例;年龄20~68岁,平均（48.5±2.4）岁;损伤节段L_（1~5）。记录手术时间并分析后凸Cobb角、VAS评分的恢复情况,并观察并发症发生情况。[结果]手术时间平均（85±12）min。术后所有患者随访7~18个月,平均11个月。Cobb角由术前平均（23.7±4.6）°,减少至术后6个月平均（5.4±2.1）°,与术前相比差异有统计学意义（P〈0.05）。VAS评分由术前平均（7.8±1.1）分,减少至术后6个月平均（1.7±0.2）分,差异有统计学意义（P〈0.05）;所有病例后路切口愈合良好,6个月CT检查均见植骨融合。[结论]自行研制的软组织保护叶片辅助腰椎结核后路椎弓根螺钉微创置入,切口小、创伤小、简便实用。

[ Objective] To design a blade device to protect soft -tissue in posterior surgery of lumbar tuberculosis, and assess its value in the minimally invasive pedicle screw fixation. [ Methods] From December 2013 to March 2015, 19 cases with lumbar tuberculosis （injured segments L1-5 ） were treated with posterior percutaneous pedicle screw fixation, including 11 males and 8 females; with the age ranging from 20 to 68 years （mean, 48. 5±2.4 years） . A self- designed blade was used to protect soft - tissue. The operation time, Cobb angle, VAS score of recovery, and complications were observed to evaluate the clinical effect of the new designed device. [Results] The mean operative time were （85 ± 12） min. All patients were followed up for 7 ~ 18 mouths, with an average of 11 months. The mean Cobb angle decreased from preoperative （23.7 ± 4. 6） ° to （5.4 ± 2. 1 ） ° at 6 months after operation, the difference was statistically significant （ P 〈 0.05 ） . The VAS score was reduced from preoperative （7.8 ± 1.1 ） points, to （ 1.7±0. 2） points at 6 months after operation, the difference was statistically signifi- cant （ P 〈 0. 05） as well. Posterior incision healed well in all cases, bone fusion was achieved within six months according to the result from CT examinations. [ Conclusion] The new designed blade of soft - tissue protection is simple and practical, it can facilitate the posterior percutaneous pedicle screw fixation, with small incision and minimal invasion.