摘要
目的:评价纹牙弧轨钉板系统在经可扩张通道固定融合术中的有效性和可靠性。方法:自2007年8月至2010年8月,采用外科手术治疗108例腰椎失稳性疾病患者,其中男61例,女47例;年龄26～57岁,平均41岁;腰椎间盘突出症23例,腰椎间盘突出症术后复发4例,腰椎管狭窄症49例,腰椎滑脱症32例。采用随机数字表法分成微创组与开放组,每组54例。微创组应用自行设计的纹牙弧轨钉板系统经可扩张通道行微创椎弓根钉固定椎间融合术,开放组采用传统开放入路椎弓根钉固定椎间融合术。对两组的手术时间、内置物置入时间、出血量进行观察;分别于术后1周、3个月、1年对两组患者的VAS评分、ODI评分及改善率进行比较;通过X线对手术前后不同时期的椎间隙高度、术后融合率进行观察。结果:所有患者切口Ⅰ期愈合,无硬脊膜撕裂、神经根或马尾损伤及椎间隙感染等并发症出现。微创组的手术时间较开放组长,术中及术后失血量明显少于开放组,椎弓根钉系统置入时间比开放组短。VAS评分:术后1周、3个月、1年两组患者的VAS评分均比术前明显下降;术后3个月开放组VAS评分比术后1周明显增加,而微创组变化不明显;术后1年两组VAS评分比术后1周、3个月均降低。ODI评分:术后3个月、1年两组患者ODI评分比术前均明显下降。术后1年两组ODI评分比术后3个月均降低。术后1周、3个月、1年,两组间VAS、ODI评分比较,微创组均低于开放组。术后1年,微创组的改善率为(77.46±6.34)%,开放组的改善率为(72.73±4.49)%,两组间差异有统计学意义(P<0.01)。术后两组椎间隙高度有明显增加。术后3个月,两组椎间隙高度差异无统计学意义;术后1年,两组椎间隙高度均有丢失,但微创组椎间隙高度大于开放组。术后1年所有患者获融合。结论:经可扩张通道微创固定融合术具有创伤小、术中出血少、术后疼痛轻、术后恢复快等特点,椎间融合率与开放手术疗效相似,是治疗腰椎失稳性疾病的一种有效方法。纹牙弧轨钉板系统设计合理,安装方便,复位效果好,固定可靠,适合可扩张通道下使用。
Objective：To evaluate the validity and reliability of Thread tooth Arc track Screw Plate System （TASPS） in the fixation fusion through expandable channels. Methods：From August 2007 to August 2010,108 patients with lumbar instability were treated with surgery,including 61 males and 47 females,ranging in age from 26 to 57 years,with an average of 41 years. All the patinets were divided into two groups：minimally invasive fusion group and traditional operation group （54 patients in each group）. The patients in the minimally invasive fusion group were treated with self designed TASPS to conduct the fixation fusion through expandable channels by minimally invasive pedicle screw;and the patients in traditional operation group were treated with traditional interbody fixation fusion by pedicle screw. The data were collected and investigated at the 1st week,3rd month and 1st year postoperatively. The comparative parameters of two groups contained the total operation time, the implanted time,the total amount of bleeding; the VAS score,ODI score and improvement rate at each investigated period; the intervertebral space height of preoperative and postoperative periods; the inefficiency rate of implantation and the fusion rate of postoperative period. Results：All incisions were healed by first stage without any complications such as dural tear,injury of nerve root or cauda equine,intervertebral space infection. The patients in the minimally invasive fusion group needed longer operative time than that of the traditional operation group,but had less total amount of intraoperative and postoperative bleeding and shorter implanted time of pedicle screw than those of the traditional operation group. The VAS scores of two groups at the 1st week after operation significantly decreased compared with that of the 1st day before the operation ,and the difference was of high statistical significance. And the VAS scores of two groups at the 3rd month and 1st year after operationalso significantly decreased compared with that of the 1st day before the operation,and the difference was highly statistically significant. By comparing the VAS score and ODI score at the 1st week,3rd month and 1st year postoperatively,the results showed that the VAS score and ODI score of the minimally invasive fusion group were all lower than those of the traditional operation group,and the differences were of high statistical meaningfulness. After 1 year,the improvement rate of the minimally invasive fusion group was （77.46 ± 6.34）%,while that of the traditional operation group was （72.73 ± 4.49）%,and the difference was highly statistically significant （P〈0.01）. The intervertebral space heights of two groups remarkably increased. At the 3rd month after operation,the difference of intervertebral space heights of the two groups was of no statistical significance. At the 1st year after operation,intervertebral space heights of the two groups were lost to some extent,but the height of the minimally invasive fusion group was higher than that of the traditional operation group ,and the difference was statistically significant. The fusion rates of the two groups after 1 year were 100%. Conclusion：The fixation fusion through expandable channels by minimally invasive pedicle screw possesses the characteristics of fewer traumas,less intraoperative blood loss,less postoperative pain and rapid recovery. Since its intervertebral fusion rate is similar to the open surgery ,it can be viewed as one effective approach for the treatment of lumbar instability diseases. And TASPS is reasonably designed,easy to install and reliably fixed with good reduction effect,which can be applied through expandable channels.
出处
《中国骨伤》
CAS
2012年第11期910-914,共5页
China Journal of Orthopaedics and Traumatology
关键词
腰椎
关节不稳定性
内固定器
外科手术
微创性
病例对照研究
Lumbar vertebrae
Joint instability
Internal fixators
Surgical procedures
minimally invasive
Casecontrol studies
