后路單側椎弓根釘固定聯合椎間融合術治療退行性腰椎失穩_《中國修復重建外科雜志》

作者：

魏富鑫 , 劉少喻 , 崔尚斌 , 王樂 , 梁春祥 , 龍厚清 , 黃陽亮

中山大學附屬第一醫院脊柱外科（廣州，510700）;

關鍵詞：

退行性腰椎失穩后路腰椎椎間融合術椎弓根釘內固定

DOI：

10.7507/1002-1892.20130155

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目的評價后路單側椎弓根釘固定聯合椎間融合術治療退行性腰椎失穩的臨床療效。方法2008年2月－2011年12月，采用后路單側椎弓根釘固定聯合椎間融合術治療退行性腰椎失穩患者33例。男20例，女13例；年齡39～75歲，平均47.2歲。病程6～25個月，平均12.8個月。腰椎間盤突出伴失穩14例，腰椎管狹窄伴失穩15例，腰椎間盤髓核摘除術后1年復發3例，極外側型腰椎間盤突出癥1例。單節段固定28例，其中L4、 5 21例，L5、S1 6例，L5、6 1例（骶椎腰化患者）；雙節段固定5例，均為L3、4、L4、5。根據Oswestry功能障礙指數（ODI）及改良下腰痛日本骨科協會（JOA）評分評價手術療效。結果術后1例發生切口感染，經換藥后愈合；其余患者切口均Ⅰ期愈合。31例獲隨訪，隨訪時間15～53個月，平均32.3個月。除1例因術后Cage移位改行雙側椎弓根釘固定外，其余患者均未發生斷釘、Cage移位或椎間假關節形成等并發癥。X線片示除1例Cage移位導致植骨融合失敗外，余均達椎間骨性愈合。末次隨訪時ODI及JOA評分均較術前及術后2周評分顯著改善（P lt; 0.05）；ODI和JOA評分改善率分別為74.0% ± 10.1%和83.6% ± 9.4%。結論后路單側椎弓根釘固定聯合椎間融合術能簡化手術操作，減小創傷，是治療退行性腰椎失穩的有效方法之一。

引用本文： 魏富鑫,劉少喻,崔尚斌,王樂,梁春祥,龍厚清,黃陽亮. 后路單側椎弓根釘固定聯合椎間融合術治療退行性腰椎失穩. 中國修復重建外科雜志, 2013, 27(6): 703-707. doi: 10.7507/1002-1892.20130155 復制

1.	朱云榮, 葉曉健, 蔣玉權, 等. 改良腰椎后路椎間植骨單側椎弓根螺釘固定在腰椎融合手術中的應用. 第二軍醫大學學報, 2010, 31(10): 1095-1099.
2.	王生介, 厲曉龍, 夏才偉, 等. 髓核摘除單側內固定椎間融合術治療腰椎間盤突出癥早期療效. 中國脊柱脊髓雜志, 2011, 21(7): 583-587.
3.	Kabins MB, Weintein JN, Spratt KF, et al. Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. Spine (Phila Pa 1976), 1992, 5(1): 39-49.
4.	Deutsch H, Musacchio MJ Jr. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus, 2006, 20(3): E10.
5.	Beringer WF, Mobasser JP. Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3): E4.
6.	Tuttle J, Shakir A, Choudhri HF. Paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation technical note and preliminary report on 47 cases. Neurosurg Focus, 2006, 20(3): E5.
7.	Cloward R. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. J Neurosurg, 1953, 10(2): 154-168.
8.	Ozdemir HM, Us AK, O?ün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
9.	Miekisiak G, Kollataj M, Dobrogowski J, et al. Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index. Spine (Phila Pa 1976), 2013, 38(4): E237-E243.
10.	孫兵, 車曉明. 日本骨科協會評估治療(JOA評分). 中華神經外科雜志, 2012, 28(6): 623.
11.	McAfee PC, Farey ID, Sutterlin CE, et al. The effects of spinal implant rigidity on vertebral bone density. A canine model. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S190-197.
12.	Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
13.	Harms T, Rolinger H. A one-stage procedure in operative treatment of spondylolietheses: dorsal traction-reposition and anterior fusion. Z Orthop Ihre Grenzgeb, 1982, 120(3): 343-347.
14.	陳家麟, 茅祖斌, 吳小濤. 四種經椎間孔腰椎間融合固定方式的三維有限元分析. 中國組織工程研究與臨床康復, 2008, 12(39): 7605-7609.
15.	Chang TS, Chang JH, Wang CS, et al. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res, 2010, 5: 86.
16.	Goel VK, Lim TH, Gwon J, et al. Effects of rigidity of an internal fixation device A. comprehensive biomechanical investigation. Spine (Phila Pa 1976), 1991, 16(3 Suppl): S155-161.
17.	楊群, 呂德成, 姜長明, 等. 單枚 cage 單側椎弓根螺釘內固定術治療退行性腰椎不穩. 中國脊柱脊髓雜志, 2009, 19(12): 909-911.
18.	Xie Y, Ma H, Li H, et al. Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics, 2012, 35(10): e1517-1523.
19.	Chen HH, Cheung HH, Wang WK, et al. Biomechanical analysis of unilateral fixation with interbody cages. Spine (Phila Pa 1976), 2005, 30(4): E92-96.
20.	Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976), 2000, 25(14): 1843-1847.

1. 朱云榮, 葉曉健, 蔣玉權, 等. 改良腰椎后路椎間植骨單側椎弓根螺釘固定在腰椎融合手術中的應用. 第二軍醫大學學報, 2010, 31(10): 1095-1099.
2. 王生介, 厲曉龍, 夏才偉, 等. 髓核摘除單側內固定椎間融合術治療腰椎間盤突出癥早期療效. 中國脊柱脊髓雜志, 2011, 21(7): 583-587.
3. Kabins MB, Weintein JN, Spratt KF, et al. Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. Spine (Phila Pa 1976), 1992, 5(1): 39-49.
4. Deutsch H, Musacchio MJ Jr. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus, 2006, 20(3): E10.
5. Beringer WF, Mobasser JP. Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3): E4.
6. Tuttle J, Shakir A, Choudhri HF. Paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation technical note and preliminary report on 47 cases. Neurosurg Focus, 2006, 20(3): E5.
7. Cloward R. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. J Neurosurg, 1953, 10(2): 154-168.
8. Ozdemir HM, Us AK, O?ün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
9. Miekisiak G, Kollataj M, Dobrogowski J, et al. Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index. Spine (Phila Pa 1976), 2013, 38(4): E237-E243.
10. 孫兵, 車曉明. 日本骨科協會評估治療(JOA評分). 中華神經外科雜志, 2012, 28(6): 623.
11. McAfee PC, Farey ID, Sutterlin CE, et al. The effects of spinal implant rigidity on vertebral bone density. A canine model. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S190-197.
12. Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
13. Harms T, Rolinger H. A one-stage procedure in operative treatment of spondylolietheses: dorsal traction-reposition and anterior fusion. Z Orthop Ihre Grenzgeb, 1982, 120(3): 343-347.
14. 陳家麟, 茅祖斌, 吳小濤. 四種經椎間孔腰椎間融合固定方式的三維有限元分析. 中國組織工程研究與臨床康復, 2008, 12(39): 7605-7609.
15. Chang TS, Chang JH, Wang CS, et al. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res, 2010, 5: 86.
16. Goel VK, Lim TH, Gwon J, et al. Effects of rigidity of an internal fixation device A. comprehensive biomechanical investigation. Spine (Phila Pa 1976), 1991, 16(3 Suppl): S155-161.
17. 楊群, 呂德成, 姜長明, 等. 單枚 cage 單側椎弓根螺釘內固定術治療退行性腰椎不穩. 中國脊柱脊髓雜志, 2009, 19(12): 909-911.
18. Xie Y, Ma H, Li H, et al. Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics, 2012, 35(10): e1517-1523.
19. Chen HH, Cheung HH, Wang WK, et al. Biomechanical analysis of unilateral fixation with interbody cages. Spine (Phila Pa 1976), 2005, 30(4): E92-96.
20. Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976), 2000, 25(14): 1843-1847.

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后路單側椎弓根釘固定聯合椎間融合術治療退行性腰椎失穩

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《中國修復重建外科雜志》

后路單側椎弓根釘固定聯合椎間融合術治療退行性腰椎失穩

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