保留小关节囊的改良椎弓根螺钉固定技术在腰椎外科手术中的应用

Modified minimally invasive method of lumbar pedicle screw placement without facet joint capsule stripping

中文关键词:  腰椎  椎弓根  内固定  手术入路

英文关键词:Minimally invasive  Pedicle  Internal fixation  Operative approach

中文摘要:

  【摘要】 目的：与传统后正中入路腰椎椎弓根螺钉内固定对比，研究一种减少剥离范围、保留小关节囊置入腰椎椎弓根螺钉的技术，以减少腰椎后正中入路椎弓根螺钉内固定的手术损伤。方法：对2008年3月～2011年12月收治的需行单节段腰椎间盘切除、椎板减压及椎间植骨融合经椎弓根螺钉内固定手术治疗的210例患者，根据患者的手术当日日期为单双号，将患者分为A组和B组，A组采用传统后正中入路（自正中口剥离至双侧小关节外侧）行腰椎减压融合手术（PLIF）100例，B组采用新技术（自正中切口剥离至小关节突内缘，保护小关节囊）行腰椎减压融合手术（PLIF）110例，其中A组年龄为48.4±0.7岁，男56例，女44例，B组年龄为47.3±0.9岁，男63例，女47例。比较两组的手术时间、术中出血量、术后引流量及置钉准确率。结果：手术均顺利完成，手术时间A组为143±12min，B组为120±13min，B组明显少于A组（P<0.05）；术中出血量A组为280±10ml，B组为170±7.5ml，B组明显少于A组（P<0.05）；术后引流量A组为216±10ml，B组为125±8ml，B组明显少于A组（P<0.05）；两组间年龄、性别、置钉准确率无显著性差异（P>0.05）。经平均19个月随访，A组融合率96.0％，B组融合率93.6％，两组间差异无显著性（P＞0.05）。结论：与传统后正中入路腰椎椎弓根螺钉内固定相比，保留小关节囊的改良腰椎椎弓根螺钉内固定技术是一种新的微创手术技术，具有创伤小、对椎旁组织损伤小、手术时间短、出血量少、引流量少的优点。

英文摘要:

  【Abstract】 Objectives: To compare the clinical results between a new pedicle screw placement without stripping facet joint capsule and conventional posterior midline approach in lumbar posterior surgery. Methods: From March 2008 to December 2011, 210 patients underwent single segment fusion and instrumentationwith pedicle screw system. According to the patient′s operation date on odd or even number, the patients were divided into 2 groups: groups A(100 case) including 56 males and 44 females, with an age of 48.4±0.7 years underwent traditional PLIF(stripping from the midline to the outside of the bilateral facet); groups B(110 cases) including 63 males and 47 females, with an age of 47.3±0.9 years underwent modified PLIF method(stripping from the midline to the medial side of facet joint for protection of the facet joint capsule). The data included operation time, intraoperative blood loss, postoperative volume of drainage, accuracy of pedicle screw placement. Results: The operation time of group A was 143±12min, while that of group B was 120±13min, which showed significant difference(P<0.05). The intraoperative blood loss of group A and B was 280±10ml and 170±7.5ml respectively, which showed significant difference(P<0.05). The postoperative volume of drainage of group A and B was 216±10ml and 125±8ml respectively, which showed significant difference(P<0.05). No significant difference was noted in terms of the age, sex and the accuracy of pedicle screw placement between 2 groups(P>0.05). The mean follow-up was 19 months, the fusion rate was 96.0% and 93.6% in group A and B, which showed no significant difference(P＞0.05). Conclusions: Compared with conventional posterior median approach of lumbar pedicle screw fixation, the modified method with facet joint capsule intact is a new minimally invasive technique, which is of time saving and blood loss decreasing.