经椎旁肌间隙入路取出腰椎椎弓根螺钉内固定系统

Clinical application of posterior paraspinal approach in removing of pedical screw fixation

中文关键词:  经椎旁肌间隙入路  椎弓根螺钉  取出

英文关键词:Paraspinal muscle approach  Pedicle screw  Removing

中文摘要:

  【摘要】 目的：探讨经椎旁肌间隙入路取出腰椎椎弓根螺钉内固定系统的可行性及临床意义。方法：2003年1月～2011年5月，65例患者在我院行腰椎椎弓根螺钉内固定系统取出，其中行传统后正中入路取出患者30例，行椎旁肌间隙入路取出患者35例。分别统计两组手术时间、手术出血量、术后并发症发生率等，并行组间比较。结果：经椎旁肌间隙入路组平均手术时间45±10min，手术出血量64±25ml，术后出现皮下血肿3例，无脑脊液漏和神经、硬膜损伤，术后并发症发生率为11.4%。传统入路组平均手术时间73±25min，手术出血量220±100ml；术后发生皮下血肿1例，切口愈合不良2例，脑脊液漏1例，术后并发症发生率13.3%。两组手术时间、手术出血量比较具有显著性差异（P<0.05），经椎旁肌间隙入路组优于传统入路组；术后并发症发生率两组无显著性差异（P>0.05）。结论：经椎旁肌间隙入路取出腰椎椎弓根螺钉内固定系统具有时间短、出血少等优点，是一种安全、损伤较小的术式。

英文摘要:

  【Abstract】 Objectives： To evaluate the clinical efficacy and significance of paraspinal muscle approach in removing pedicle screw fixation. Methods： Clinical materials of 65 patients who had pedicle screw removing, were collected between January 2003 and May 2011. Study group included 35 patients who received operations with paraspinal muscles approach. Control group included 30 patients who received operations with conventional posterior midline approach. Mean-operative time, mean-blood loss, postoperative complication rate were compared between study group and control group. Statistical analysis was used. Results： In study group receiving operations with paraspinal muscle approach, mean operative time was 45±10min; mean blood loss was 64±25ml; incision hematoma was found in 3 patients; there was no case with cerebrospinal fluid leakage, cauda and dural injury; postoperative complication rate was 11.4%. In control group receiving operations with conventional approach, mean operative time was 73±25min; mean blood loss was 220±100ml; incision hematoma was found in 1 case; incision poor healing was found in 2 cases; postoperative complication rate was 13.3%. There were significant differences in mean operation time and mean blood loss between two groups(P<0．05). In complication rate there was no significant difference(P＞0.05). Conclusions： Paraspinal muscle approach for removing pedical screw fixation shows less mean operation time, less bleeding. It provides a safe, effective, minimally invasive surgical option.