经皮置入经椎板关节突螺钉方法的研究

A study of percutaneous translaminar facet screws

目的：介绍经椎板关节突螺钉（ TLFS）安全经皮置入技术并评价这项技术的可行性和临床效果。方法13例单节段腰椎退变性疾病患者，采用单侧切口进行微创经椎间孔腰椎体间融合术（ minimally invasive transfo-raminal lumbar interbody fusion，MIS－TLIF ），置入单侧椎弓根螺钉后透视引导下经皮向对侧置入经椎板关节突螺钉。观察手术时间、术中出血量和术后引流量，术后评价椎板关节突螺钉位置，分析置入经椎板关节突螺钉失败率、手术并发症及融合率。结果随访12～24个月，平均18个月。经皮安全置入椎板关节突螺钉手术时间短，术中出血量少（无输血），术后切口引流量少。本组共置入了13枚螺钉，1枚螺钉（7．7％）穿破椎板，但未损伤神经根。所有螺钉均经过关节突关节，11枚螺钉（84．6％）置入理想的位置。术后无切口感染、皮肤坏死，术中、术后未出现脑脊液漏，无神经损伤等并发症。影像学检查所有椎体均获得椎间融合，融合率为100％。结论进行MIS－TLIF手术，置入单侧椎弓根螺钉后透视引导下经皮向对侧置入经椎板关节突螺钉技术是一项简单易行、创伤小、可广泛推广的技术。

Objective To introduce the use of percutaneous translaminar facet screw （ TLFS） for safety placement, and to assess its technical feasibility and clinical efficacy.Methods A retrospective analysis was performed on 13 pa-tients who underwent minimally invasive transforaminal lumbar interbody fusion （ MIS-TLIF ） using unilateral pedical screws as well as contralateral percutaneous translaminar facet screws under fluoroscopic guidance in our hospital.The op-eration time, blood loss during operation and postoperative drainage volume were observed.The position of facet screws, complications, failure rate and fusion rate were evaluated after operation.Results The follow-up visit time ranged from 12 to 24 months, at an average of 18 months.Percutaneous translaminar facet screw fixation required a shorter time and a less volume of postoperative drainage, without blood loss and transfusion.A total of 13 screws were inserted.There was one screw （7.7%） violated the vertebral laminae without nerve root injure.All screws past the facet joints, while 11 screw were inserted into perfect positions （84.6%）.No incision infection, skin necrosis, cerebrospinal fluid leakage, nerve injury and other complications were reported.IntervertebraI fusion occurred in all fused levels according to radiolog-ical examination （100%） .Conclusion Percutaneous translaminar facet screw fixation under fluoroscopic guidance is a simple operation with minimal incision and can be widely applied.