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[1]王海峰,曾忠友,金輝.雙側皮質骨軌跡椎弓根螺釘內固定聯(lián)合椎間融合治療腰椎退行性病變[J].中醫(yī)正骨,2020,32(05):52-56.
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雙側皮質骨軌跡椎弓根螺釘內固定聯(lián)合椎間融合治療腰椎退行性病變()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年05期
頁碼:
52-56
欄目:
臨床報道
出版日期:
2020-05-20

文章信息/Info

作者:
王海峰曾忠友金輝
(中國人民武裝警察部隊海警總隊醫(yī)院,浙江 嘉興 314033)
關鍵詞:
腰椎 椎間盤移位 脊椎滑脫 椎管狹窄 脊柱融合術
摘要:
目的:探討雙側皮質骨軌跡(cortical bone trajectory,CBT)椎弓根螺釘內固定聯(lián)合椎間融合治療腰椎退行性病變的臨床療效和安全性。方法:2014年6月至2016年12月收治92例腰椎退行性病變患者。男56例,女36例。年齡39~72歲,中位數(shù)53歲。腰椎間盤突出癥59例,腰椎椎管狹窄癥19例,腰椎退行性滑脫(MeyerdingⅠ度)14例。均為單節(jié)段病變,其中L3~426例、L4~542例、L5S124例。均采用雙側CBT椎弓根螺釘內固定聯(lián)合椎間融合治療。采用視覺模擬量表(visual analogue scale,VAS)評定患者的腰痛程度,采用日本骨科學會腰背痛調查問卷(Japanese Orthopedic Association back pain evaluation questionnaire,JOABPEQ)評定總體療效。測量病變節(jié)段椎間隙高度、腰椎冠狀位和矢狀位Cobb角,并評價CBT螺釘?shù)奈恢眉白甸g融合情況。觀察治療及隨訪期間并發(fā)癥的發(fā)生情況。結果:所有患者的手術均順利完成,且均獲得12個月以上隨訪。手術時間65~130 min,中位數(shù)85 min。術中出血量140~420 mL,中位數(shù)270 mL; 所有患者均未輸血; 術后引流量110~250 mL,中位數(shù)160 mL。1例患者術中發(fā)生硬脊膜損傷并腦脊液漏,由于硬脊膜囊破裂口較小,術中以明膠海綿填壓硬脊膜囊破裂處,術后保持頭低腳高位,未出現(xiàn)腦脊液漏及神經損傷癥狀; 2例患者發(fā)生終板損傷,術后絕對臥床2周并且佩戴胸腰支具2個月,隨訪X線片顯示融合器部分嵌入椎體內。切口均甲級愈合。8例8個節(jié)段的椎間融合器發(fā)生沉降。未發(fā)生椎間隙感染、神經損傷、螺釘松動及斷裂、椎間融合器移位、鄰近節(jié)段退變等并發(fā)癥。86例患者的362枚CBT螺釘位置為Ⅰ度; 6例患者的6枚CBT螺釘位置為Ⅱ度,均未出現(xiàn)神經根損傷癥狀,未調整螺釘位置。至末次隨訪時,8例椎間融合器內骨質稀疏、可見部分透亮線,不能明確椎間是否融合,其余84例均獲得椎間融合。術前、術后6 d及末次隨訪時病變節(jié)段椎間隙高度分別為(9.6±1.5)mm、(11.5±1.4)mm、(11.1±1.3)mm; 術前及末次隨訪時的腰椎冠狀面Cobb角分別為3.24°±0.89°、1.21°±1.15°; 術前及末次隨訪時的腰椎矢狀面Cobb角分別為42.80°±8.17°、50.20°±7.47°。術前、術后6 d及末次隨訪時的腰部疼痛VAS評分分別為(6.2±0.5)分、(2.2±0.6)分、(1.2±0.6)分; 術前、術后6 d及末次隨訪時的JOABPEQ評分分別為(12.13±1.76)分、(24.30±1.56)分、(25.30±1.66)分。結論:雙側CBT椎弓根螺釘內固定聯(lián)合椎間融合治療腰椎退行性病變,可有效減輕患者的腰部疼痛癥狀、改善腰部功能,總體療效較好,安全性較高。

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備注/Memo

備注/Memo:
(收稿日期:2019-09-24 本文編輯:李曉樂)基金項目:嘉興市科技計劃項目(2017AY33061)通訊作者:金輝 E-mail:[email protected]
更新日期/Last Update: 2020-08-15