椎弓根内侧缘置钉法在常规置钉困难的腰椎退行性疾病中的应用研究

Study on the application of inner pedicle screw fixation in the treatment of lumbar degenerative diseases difficult to be treated with conventional screw fixation

目的:研究椎弓根内侧缘置钉法在常规置钉困难的腰椎退行性疾病中的应用价值。方法:回顾性分析188例常规置钉困难的腰椎退行性疾病患者的临床资料。根据椎弓根置钉法不同对患者进行分组,采用椎弓根内侧缘置钉法患者纳入观察组(n=112),采用常规置钉法患者纳入对照组(n=76),比较两组患者术中情况、置钉准确性、一次性置钉成功率、术后情况、疼痛评分、腰椎功能评分以及置钉并发症的差异。结果:观察组置钉时间、透视次数、手术时间分别为(20.25±3.29)min、(7.82±2.51)次、(158.87±47.17)min,显著低于对照组的(23.11±6.46)min、(8.96±2.66)次、(183.46±62.63)min(P<0.05);观察组一次性置钉成功率、置钉准确性优良率分别为90.6%、85.5%,显著高于对照组的85.3%、76.6%(P<0.05),置钉并发症总发生率(8.9%)显著低于对照组(19.7%)(P<0.05)。结论:椎弓根内侧缘置钉法可以提高一次性置钉成功率与置钉准确性,减少置钉相关并发症发生,有利于腰椎退行性疾病患者术后恢复。

Objective：To study the application of inner pedicle screw fixation in the treatment of lumbar degenerative diseases difficult to be treated with conventional screw fixation. Methods：188 cases of patients with lumbar degenerative diseases difficult to be treated with conventional screw fixation were analyzed retrospectively. The patients were divided into the observation group（ treated with inner pedicle screw fixation,n = 112） and the control group（ treated with conventional screw fixation,n = 76） according different methods for screw fixation. The intraoperative condition,accuracy of screw placement,success rate of one-time screw placement,postoperative condition,pain score,lumbar function score and complications were compared between the two groups. Results：There were significant differences in time for screw placement,times of fluoroscopy and operation time between the observation group and the control group[（20. 25 ± 3. 29） min,（7. 82 ± 2. 51） times and（158. 87 ± 47. 17） min vs.（23. 11 ± 6. 46） min,（8. 96 ± 2. 66） times and（183. 46 ± 62. 63） min]（P〈0. 05）. The success rate of one-time screw placement and the excellent and good rate of accuracy of screw placement in the observation group were significantly higher than those in the control group（90. 6% and 85. 5% vs. 85. 3% and76. 6%）（ P〈0. 05）. The total incidence of complications in the observation group was lower than that in the control group（8. 9% vs.19. 7%）（ P〈0. 05）. Conclusion：The inner pedicle screw fixation can improve the success rate of one-time screw placement and the accuracy of screw placement,reduce the complications,which is good for the recovery of patients with lumbar degenerative diseases.