目的比较椎体轴位像椎弓根投影法结合经皮椎弓根钉内固定与切开复位内固定治疗胸腰椎压缩骨折的临床疗效。方法回顾性分析自2015-02—2018-02诊治的100例胸腰椎压缩骨折,50例采用椎体轴位像椎弓根投影法结合经皮椎弓根钉内固定术治疗(...目的比较椎体轴位像椎弓根投影法结合经皮椎弓根钉内固定与切开复位内固定治疗胸腰椎压缩骨折的临床疗效。方法回顾性分析自2015-02—2018-02诊治的100例胸腰椎压缩骨折,50例采用椎体轴位像椎弓根投影法结合经皮椎弓根钉内固定术治疗(经皮组),50例采用切开复位内固定术治疗(开放组)。比较2组术后1 d E角偏差及置钉点偏差,比较2组术后1周与术后1年伤椎Cobb角、椎体前缘高度。结果100例均完成手术并获得随访,随访时间12~18.2个月,平均15.4个月。术后1 d经皮组E角偏差与置钉点偏差较开放组小,差异有统计学意义(P<0.05);术后1周、术后1年2组伤椎Cobb角以及术后1周2组椎体前缘高度比较差异无统计学意义(P>0.05),术后1年经皮组椎体前缘高度较开放组大,差异有统计学意义(P<0.05)。结论经皮椎弓根钉内固定术前行椎体轴位像椎弓根投影法分析可明确置钉的进钉点、角度、深度、可置钉安全区域,在三维空间里找到关节突及椎板表面对应位置,能有效减少椎弓根、椎管损伤及神经损伤的概率。展开更多
Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was c...Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior(group A) or posterior(group B) correction and fusion surgery from December 1998 to May 2008.The correction of the main curve and changes of the disc wedging were analyzed.Results Fifty-three patients were included,26 in group A and 27 in group B.The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery(P<0.05),with an average correction rate of 75.2% and 88.2%,respectively.Upon final follow-up,the coronal Cobb angles of the two groups were 18.9°±11.1° and 7.7°±5.6°,respectively,with an average correction loss of 6.8°±6.5° and 2.7°±3.3°,respectively.The coronal Cobb angle after operation and at final follow-up,and the correction rate were significantly better in group B than those in group A(P<0.05),while the coronal Cobb angle loss in group A was greater than that in group B(P<0.05).The disc wedging before operation,after operation,and at final follow-up were 3.2°±3.0°,5.7°±3.0°,and 8.6°±4.4° in group A,and 2.4°±3.2°,3.3°±3.4°,and 3.7°±3.6° in group B,respectively.Postoperative disc wedging was significantly larger compared with preoperative measurements in group A(P<0.05),but not in group B(P>0.05).The difference between disc wedging at final follow-up and that after surgery was significant in group A(P<0.05),but not in group B(P>0.05).Between the two groups,group A had larger disc angles after operation and at final follow-up(P<0.05),and a greater loss of disc angle(P<0.05).Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis,posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.展开更多
Objective： To explore the advantages and indications of the paraspinal approach by anatomical study and clinical application.Methods： The anatomical data and clinical practice of 27 cases were analyzed to explore th...Objective： To explore the advantages and indications of the paraspinal approach by anatomical study and clinical application.Methods： The anatomical data and clinical practice of 27 cases were analyzed to explore the accurate approach between the paraspinal muscles and the structure of ambient tissues, as well as the results of clinical application of paraspinal approach. The operation time, blood loss, incision length, radiographic result （Cobb angle, height of anterior edge of the vertebrae） were compared with those in 24cases treated by traditional approach.Results： Complete exposure of the facets could be easily performed by identifying natural cleavage plane between the multifidus and Iongissimus muscles. The natural muscular cleavage was （1.47±0.23） cm lateral to the midline for females, and （1.64±0.35） cm for males at T12 level. The distance was （3.3±0.6） cm lateral to the midline for females,and （3.7±1.0） cm for males at L4 level. In paraspinal approach group, the operation time was （76.2±15.7） min, blood loss was （91.6±16.9） ml and incision length was （7.6±0.8） cm. In traditional approach group, the operation time was （121.4±19.6） min, blood loss was （218.7±32.3 ） ml and incision length was （17.4±2.1） cm. To compare paraspinal approach with traditional approach, the operation time, blood loss and incision length had statistical difference （P〈0.05） and the radiographic result （Cobb angle, height of anterior edge of the vertebrae） had no statistical difference （P〉0.05）.Conclusions： When the paraspinal approach is performed through natural cleavage plane between the multifidus and longissimus muscles, there are no wide muscular disinsertions, leaving the supraspinous and interspinous ligaments intact. The distance of natural cleavage to the midline is different at T12 and L4 planes. By this approach,the facet joints can be explored easily and completely, and a clear surgical field will be available for the placement of pedicle screws. As a minimally invasive approach, it can be widely used in thoracolumbar spine surgery.展开更多
文摘目的比较椎体轴位像椎弓根投影法结合经皮椎弓根钉内固定与切开复位内固定治疗胸腰椎压缩骨折的临床疗效。方法回顾性分析自2015-02—2018-02诊治的100例胸腰椎压缩骨折,50例采用椎体轴位像椎弓根投影法结合经皮椎弓根钉内固定术治疗(经皮组),50例采用切开复位内固定术治疗(开放组)。比较2组术后1 d E角偏差及置钉点偏差,比较2组术后1周与术后1年伤椎Cobb角、椎体前缘高度。结果100例均完成手术并获得随访,随访时间12~18.2个月,平均15.4个月。术后1 d经皮组E角偏差与置钉点偏差较开放组小,差异有统计学意义(P<0.05);术后1周、术后1年2组伤椎Cobb角以及术后1周2组椎体前缘高度比较差异无统计学意义(P>0.05),术后1年经皮组椎体前缘高度较开放组大,差异有统计学意义(P<0.05)。结论经皮椎弓根钉内固定术前行椎体轴位像椎弓根投影法分析可明确置钉的进钉点、角度、深度、可置钉安全区域,在三维空间里找到关节突及椎板表面对应位置,能有效减少椎弓根、椎管损伤及神经损伤的概率。
文摘Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior(group A) or posterior(group B) correction and fusion surgery from December 1998 to May 2008.The correction of the main curve and changes of the disc wedging were analyzed.Results Fifty-three patients were included,26 in group A and 27 in group B.The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery(P<0.05),with an average correction rate of 75.2% and 88.2%,respectively.Upon final follow-up,the coronal Cobb angles of the two groups were 18.9°±11.1° and 7.7°±5.6°,respectively,with an average correction loss of 6.8°±6.5° and 2.7°±3.3°,respectively.The coronal Cobb angle after operation and at final follow-up,and the correction rate were significantly better in group B than those in group A(P<0.05),while the coronal Cobb angle loss in group A was greater than that in group B(P<0.05).The disc wedging before operation,after operation,and at final follow-up were 3.2°±3.0°,5.7°±3.0°,and 8.6°±4.4° in group A,and 2.4°±3.2°,3.3°±3.4°,and 3.7°±3.6° in group B,respectively.Postoperative disc wedging was significantly larger compared with preoperative measurements in group A(P<0.05),but not in group B(P>0.05).The difference between disc wedging at final follow-up and that after surgery was significant in group A(P<0.05),but not in group B(P>0.05).Between the two groups,group A had larger disc angles after operation and at final follow-up(P<0.05),and a greater loss of disc angle(P<0.05).Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis,posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.
基金This study was supported by National Natural Science Foundation of China （No.30772209）.
文摘Objective： To explore the advantages and indications of the paraspinal approach by anatomical study and clinical application.Methods： The anatomical data and clinical practice of 27 cases were analyzed to explore the accurate approach between the paraspinal muscles and the structure of ambient tissues, as well as the results of clinical application of paraspinal approach. The operation time, blood loss, incision length, radiographic result （Cobb angle, height of anterior edge of the vertebrae） were compared with those in 24cases treated by traditional approach.Results： Complete exposure of the facets could be easily performed by identifying natural cleavage plane between the multifidus and Iongissimus muscles. The natural muscular cleavage was （1.47±0.23） cm lateral to the midline for females, and （1.64±0.35） cm for males at T12 level. The distance was （3.3±0.6） cm lateral to the midline for females,and （3.7±1.0） cm for males at L4 level. In paraspinal approach group, the operation time was （76.2±15.7） min, blood loss was （91.6±16.9） ml and incision length was （7.6±0.8） cm. In traditional approach group, the operation time was （121.4±19.6） min, blood loss was （218.7±32.3 ） ml and incision length was （17.4±2.1） cm. To compare paraspinal approach with traditional approach, the operation time, blood loss and incision length had statistical difference （P〈0.05） and the radiographic result （Cobb angle, height of anterior edge of the vertebrae） had no statistical difference （P〉0.05）.Conclusions： When the paraspinal approach is performed through natural cleavage plane between the multifidus and longissimus muscles, there are no wide muscular disinsertions, leaving the supraspinous and interspinous ligaments intact. The distance of natural cleavage to the midline is different at T12 and L4 planes. By this approach,the facet joints can be explored easily and completely, and a clear surgical field will be available for the placement of pedicle screws. As a minimally invasive approach, it can be widely used in thoracolumbar spine surgery.
