椎弓根内侧缘置钉法在常规置钉困难的腰椎退行性疾病应用研究

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。方法回顾性分析我院2015-01-2016-06收治的188例常规置钉困难的腰椎退行性疾病患者。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。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为1.8%显著低于对照组的9.2%(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 value of inner pedicle screw fixation in the treatment of lumbar degenerative diseases difficult to be treated with conventional screw fixation.Methods From January 2015 to June 2016,the clinical data of 188 patients with lumbar degenerative diseases difficult to be treated with conventional screw fixation who admitted in the hospital 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 to 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 The time for screw placement,times of fluoroscopy and operation time in the observation group were(20.25±3.29)min,(7.82±2.51)times and(158.87±47.17)min,which were significantly lower than those in the control group[(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%and 76.6%,P<0.05).The incidence rate of complications in the observation group was significantly lower than that in the control group(1.8%vs 9.2%,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 associated with screw placement,which is good for the recovery of patients with lumbar degenerative diseases.