微创经椎间孔腰椎椎间融合术中横突定位法置钉的影像学评价

Imaging evaluation of transerve process placement of lumbar pedicle screws in the operation of minimally invasive transforaminal lumbar interbody fusion

中文关键词:  横突定位  椎弓根螺钉  影像学评价

英文关键词:Transverse process placement  Pedicle screws  Imaging evaluation

中文摘要:

  【摘要】 目的：探讨在微创经椎间孔腰椎椎间融合术（minimally invasive transforaminal lumbar interbody fusion，MISTLIF）中采用横突定位法置钉的可行性及术后影像学评价。方法：回顾分析2014年1月~2014年12月行MISTLIF手术患者82例，根据置钉位置进行分组，其中治疗组（40例）按横突定位法置钉，其中男18例，女22例，平均年龄55.4±5.0岁（46~67岁）。对照组（42例）以“人字嵴”顶点法置钉，其中男20例，女22例，年龄56.2±5.5岁（47~70岁），术后平均随访24.0±3.5个月。分别记录两组出血量、手术时间，术后1年复查腰椎CT平扫+三维重建。按照Rao分级评估椎弓根螺钉穿出情况，CT轴位测量椎弓根螺钉水平角（transverse section angle，TSA），CT矢状位测量矢状角（sagittal section angle，SSA）。CT轴位评估椎弓根螺钉对头侧邻近节段关节突关节破坏（facet joint violation，FJV）情况。结果：两组年龄、性别、术前诊断构成比差异无统计学意义（P＞0.05），治疗组手术时间为95.0±10.5min，出血量为120.0±11.2ml，对照组手术时间为150.0±10.5min，出血量150.0±11.5ml，两组出血量差异无统计意义（P＞0.05），但两组手术时间差异具有统计学意义（P＜0.05）。Rao分级法评估椎弓根螺钉穿出情况两组椎弓根螺钉穿出率，差异无统计学意义（P＞0.05）。治疗组与对照组相比，SSA无统计学差异（P＞0.05），TSA具有统计学意义（P＜0.05）。两组FJV发生率差异具有统计学意义（P＜0.05）。结论：横突定位法，与“人字嵴”顶点法相比，均具有较高的置钉准确率，横突置钉法头侧邻近节段关节突关节破坏率低，且有利于通道下操作、缩短了置钉时间，但横突定位法置钉时进钉点偏外，术中需适当增大TSA。

英文摘要:

  【Abstract】 Objectives: To discuss transverse process placement of lumbar pedicle screws in the operation of minimally invasive transforaminal lumbar interbody fusion(MISTLIF) and imaging evaluation at postoperation. Methods: Retrospectively analysis was performed on 82 patients who underwent MISTLIF from January 2014 to December 2014 in our hospital. 40 patients， 18 cases of male, 22 cases of female, the average age was 55.4±5.0(46-67) years old, who were placed the lumbar pedicle screws by superior margin of transverse process root were in the treatment group; 42 patients, 20 cases of male, 22 cases of female, the average age was 56.2±5.5(47-70) years old, who were placed the pedicle screws by "∧" shape crest were in the control groups. The operation time and blood loss were all documented. All patients were followed up for 24.0±3.5 months postoperation, CT three dimensional reconstruction examined at 1 year follow-up. The position of pedicle screws was evaluated by Rao classification. The transverse and sagittal section angle of the pedicle screws were measured by CT scan. The cranial facet joint violation was also evaluated by the transverse section of CT scan. Results: There was no statistical significance between the two groups about age, gender or preoperative diagnosis(P>0.05). The average operation time of treatment group was 95.0±10.5min, the average blood loss was 120.0±11.2ml, the average operation time of control group was 150.0±10.5min, the average blood loss was 150.0±11.5ml, there was no statistical significance between the two groups about the blood loss(P>0.05), but there was statistical significance about the operation time(P<0.05). The position of pedicle screws in the treatment had no statistical significance of perforation ratio of pedicle between the two groups(P<0.05). There was no statistical significance of SSA between the two groups(P>0.05). However, the TSA had statistical significance(P<0.05). There was statistical significance of FJV between the two groups(P<0.05). Conclusions: The transverse process placement of pedicle screws technique can place the pedicle screws accurately with low cranial FJV rate and is appropriated to MISTLIF, comparing with the "∧" shape crest pedicle placement technique. However, the entrypoint is lateral to "∧" shape crest, the TSA should be added in the operation, in order to prevent perforation of lateral cortex of the pedicle.