纹牙弧轨钉板系统在微创通道下腰椎融合术中的应用

Application of thread-tooth arc-track screw plate system in the minimally invasive lumbar fusion

中文关键词:  腰椎失稳  内固定  微创  腰椎融合

英文关键词:Lumbar instability  Internal fixation  Minimally invasive  Interbody fusion

中文摘要:

  【摘要】 目的：观察自行设计的纹牙弧轨钉板系统在可扩张通道下行腰椎固定融合术中应用的有效性、可靠性。方法： 2008年2月~2011年2月，对132例腰椎失稳性疾病患者经可扩张通道行微创固定融合手术，随机分成观察组和对照组，观察组应用自行设计的纹牙弧轨钉板系统固定，对照组采用椎弓根钉棒系统固定，分别于术后1周、3个月和1年时复查。比较两组的总手术时间、钉板（钉棒）置入时间、总出血量；各时间点VAS评分、ODI及改善率；术前和术后3个月、1年时的椎间隙高度；术后1年的融合率。结果：所有患者均在微创通下完成手术，切口均Ⅰ期愈合，无严重并发症出现。观察组的手术时间、钉板置入时间较对照组短，术中及术后总失血量少于对照组。两组术后1周、3个月和1年时的VAS评分与术前比较均有显著性差异，两组同一时间点比较无显著性差异；术后3个月ODI明显改善，与术前比较有显著性差异，术后1年进一步改善，与术后3个月比较有显著性差异，观察组改善率为（79.46±6.34）％，对照组改善率为（76.73±4.49）％，两组间差异有统计学意义（P＜0.05）。术后椎间高度明显改善，1年时两组椎间隙高度均有丢失，但仍显著高于术前，观察组椎间隙高度丢失大于对照组。术后1年时，观察组融合率为98.48%，对照组融合率为87.88%，两组差异有显著性（P＜0.05）。结论：纹牙弧轨钉板系统在微创通道下行腰椎固定融合术安装方便，固定可靠，适合在可扩张通道下使用。

英文摘要:

  【Abstract】 Objectives: To observe the reliability of the self-design thread-tooth arc-track screw plate system(TASPS) in minimally invasive lumbar fusion. Methods: From February 2008 to February 2011, 132 cases with lumbar instability were treated by minimally invasive lumbar fusion. All cases were divided into observation group and control group. The observation group underwent self-designed TASPS, while the control group underwent pedicle screw fixation system. The data including operation time, instrumentation time, blood loss, VAS score, ODI and improvement rate were collected and investigated at 1 week, 3 months and 1 year postoperatively. The disc height at 3 months and 1 year and the fusion rate at 1 year were also reviewed. Results: All patients underwent minimally invasive operation, all skin incisions healed without any complication. The observation group had shorter operation and instrumentation time than control group, and less blood loss. The VAS scores of two groups at 1 week, 3 months and 1 year after operation were significantly lower than the preoperative ones. ODI score improved after 3 months, which showed significant difference than that before operation, and further improvement at 1 year after operation was noted, which showed significant difference compared with that at 3 months after operation. After 1 year, the improvement rate in observation group was (79.46±6.34)％, while (76.73±4.49)％ for control group, and the difference was significant(P<0.05). The postoperative disc heights got improved, but lost in two groups 1 year after operation, but still higher than the preoperative ones, which of observation group was higher than control group; 1 years after operation, the fusion rates in observation group was 98.48%; while 87.88% for control group, which showed significant difference between two groups(P<0.05). Conclusions: TASPS is simple reliable for minimal invasive lumbar fusion.