单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定治疗下腰椎病变的临床观察

摘要

Objective To investigate the feasibility and efficiency of unilateral pedicle screw combined with contralateral translaminar facet screw fixation by percutaneous and interbody fusion to treat low lumbar vertebra diseases. Methods Thirty patients with low lumbar vertebra diseases were entered into the study, including 8 males and 22 females with an average age of 53.7 years. All patients underwent discectomy, spinal canal decompression, cage implantation and lumbar fixation by unilateral pedicle screw combined with contralateral translaminar facet screw under gunsight guiding by percutaneous. Clinical outcomes were assed by JOA questionnaires before and after operation. Operative time, blood loss, and postoperative draiming were recorded. Radiological examination was obtained to assess position of translaminar facet screw.Results Mean operation time was 89 min with a blood loss of 285 ml. Position of translaminar facet screw grade Ⅰ were 24 cases, and grade 11 were 6. Mean follow-up was 22.5 months. 29 cases got bony fusion, and the fusion rate was 96.7%. There were no instability and evidence instrument failure during follow-up. The JOA grades improved from 13.0 preoperation to 25.2 at final follow-up, with the excellent and good rate of 72.5 %. Conclusion Unilateral pedicle screw combined with contralateral translaminar facet screw fixation by percutaneous and interbody fusion provide simple procedure, little trauma, forceful fixation, high fusion rate, and less complication, etc. Therefore, the surgical maneuver is a good choice for partial low lumbar vertebra diseases.%目的 探讨单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定治疗下腰椎病变的可行性和疗效.方法 男8例,女22例;年龄39～68岁,平均53.7岁.腰椎间盘退变11例,腰椎间盘突出症术后原位复发4例,巨大型腰椎间盘突出5例,腰椎间盘突出伴椎管狭窄4例,腰椎退行性滑脱(Ⅰ度)6例.L3,42例、L4,5 20例、L5S1 8例.采用单侧显露、减压、同侧椎弓根螺钉固定,同时在自行设计的瞄准器引导下经皮对侧进行椎板关节突螺钉固定并椎间融合器植骨方法治疗.观察手术时间、术中出血量和术后引流量.通过影像学评价椎板关节突螺钉位置.采用日本骨科学会(Japanese Orthopaedic Association,JOA)下腰痛评分系统(29分法)评价疗效.结果 手术时间75～110 min,平均89 min;术中出血量为180～500ml,平均285 ml,均未输血.椎板关节突螺钉位置Ⅰ型24例,Ⅱ型6例.术后2例病例出现终板切割,融合器部分陷入终板及椎体内.随访时间12～36个月,平均22.5个月.除1例不能明确外,其余均获得骨性融合,融合率为96.7%.随访过程中椎弓根螺钉与椎板关节突螺钉未出现松动、移位、断裂,椎间融合器亦无移位现象.JOA评分由术前的10～16分(平均13.0分)提高到22～27分(平均25.2分),改善率为61.7%～90.5%,平均72.5%.结论 单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定具有操作简单、创伤小、稳定性好、融合率高和并发症少等优点,是部分下腰椎病变固定融合的较好选择.