椎弓根双螺钉技术在腰椎椎间融合术后邻椎病翻修术中的应用

Double pedicle screws technique in revision surgery for adjacent segment disease following lumbar interbody fusion

目的:探讨椎弓根双螺钉技术(DPST)在腰椎椎间融合术后邻椎病(ASD)翻修术中应用的临床疗效。方法:回顾性分析2019年1月至2021年12月应用DPST治疗的32例ASD患者的临床资料,男11例,女21例,年龄51~74岁,平均(65.6±7.3)岁。初次手术融合节段位于L2~S1,融合范围为2~4个运动节段。记录ASD翻修术的手术时间、术中出血量、椎弓根螺钉型号,在术后CT片上测量椎弓根螺钉在骨质内的有效长度,观察椎弓根破壁情况。结果:手术时间为90~180 min,平均(132.4±55.1)min;术中失血量为300~500 mL,平均(402.3±115.6)mL。共置入64枚DPST螺钉,螺钉直径5.5 mm 24枚、6.0 mm 40枚。总体置钉成功率为84.4%(54/64)。随访时间12~24个月,平均(18.4±5.7)个月。至末次随访,未发生内固定松动。原椎弓根螺钉与DPST螺钉的钉道长度比较差异无统计学意义。结论:在多节段腰椎椎间融合术后ASD的翻修术中,DPST是一种安全有效的手术方式,具有手术操作简单及创伤小的优点。

Objective:To investigate the clinical efficacy of the double pedicle screws technique(DPST)in revision surgery for adjacent segment disease(ASD)following lumbar interbody fusion.Methods:A retrospective analysis was conducted on the clinical data of 32 ASD patients who underwent treatment with DPST from January 2019 to December 2021.Among them,there were 11 males and 21 females,aged between 51 and 74 years,with a mean age of(65.6±7.3)years.The initial fusion segment was located between L2 and S1,with a fusion range of 2 to 4 motion segments.Surgical duration,intraoperative blood loss,and pedicle screw size were recorded during ASD revision surgery.The effective length of pedicle screws within the bone was measured via postoperative CT scans,and breaches of the pedicle wall were observed.Results:Surgical duration ranged from 90 to 180 minutes,with a mean of(132.4±55.1)minutes.Intraoperative blood loss ranged from 300 to 500 mL,with a mean of(402.3±115.6)mL.A total of 64 DPST screws were implanted,comprising 24 screws with a diameter of 5.5 mm and 40 screws with a diameter of 6.0 mm.The overall success rate of screw placement was 84.4%(54/64).The patients were followed up for a period ranging from 12 to 24 months,with a mean duration of(18.4±5.7)months.No loosening of the internal fixation was observed at the last follow-up.There was no statistically significant difference in the nail length between the traditional pedicle screws and DPST screws.Conclusions:In revision surgery for ASD following multi-segment lumbar interbody fusion,DPST is a safe and effective surgical technique with the advantages of simple operation and less trauma.