椎弓根镜辅助下置钉与传统经皮置钉治疗LDD的临床评价

发布时间：2018-02-19 23:50

  本文关键词： 经皮椎弓根螺钉 椎弓根镜 微创内固定术 腰椎退行性疾病 治疗结果　出处：《重庆医学》2017年18期 　论文类型：期刊论文

【摘要】：目的比较传统经皮置钉与椎弓根镜辅助下经皮置钉技术治疗腰椎退行性疾病(LDD)的安全性和准确性。方法选择广州医科大学附属第一医院2013年12月至2015年9月采用经皮置钉的LDD患者30例,将其分为经皮组和镜下组,每组15例,比较两组患者术中出血量、住院时间及并发症,采用视觉模拟量表(VAS)和Oswestry功能障碍指数(ODI)进行疗效评估。术后复查X线、CT及磁共振成像(MRI),评估螺钉位置及融合率。结果经皮组置钉84枚,镜下组置钉70枚。两组术中平均出血、手术平均时间、C臂透视平均次数、住院平均时间、术后下床时间及并发症发生率比较差异无统计学意义(P0.05)。随访6个月,两组患者VAS及ODI评分较术前明显改善(P0.01);镜下组VAS及ODI分别为(2.50±1.30)分及(50.00±3.50)%,经皮组VAS及ODI分别为(3.00±1.50)分及(58.00±4.50)%,两组比较差异有统计学意义(P0.05)。经皮组、镜下组临床症状改善率为73.33%、80.00%;置钉位置经影像学复查,显示位置良好,病变节段融合良好,无螺钉松动。经皮组3枚(3.57%)螺钉位置偏差,行二次手术调整。结论椎弓根镜辅助下置钉治疗LDD的准确性及安全性均高于传统经皮置钉,且手术时间更短,术中出血更少。
[Abstract]:Objective to compare the safety and accuracy of traditional percutaneous nail and pedicle screw assisted percutaneous nail in the treatment of lumbar degenerative diseases. Methods the first affiliated Hospital of Guangzhou Medical University was selected from December 2013 to September 2015. There were 30 cases of LDD with percutaneous nail insertion. The patients were divided into percutaneous group (n = 15) and endoscopic group (n = 15). The amount of intraoperative bleeding, hospital stay and complications were compared between the two groups. Visual analogue scale (vas) and Oswestry dysfunction index (ODI) were used to evaluate the efficacy. After operation, X-ray CT and Mr imaging were performed to evaluate the screw position and fusion rate. Results 84 screws were placed in the percutaneous group and 70 nails were placed under the microscope. There was no significant difference in the average time of operation, the average time of hospitalization, the time of getting out of bed after operation and the incidence of complications (P 0.05). All patients were followed up for 6 months. The scores of VAS and ODI in the two groups were significantly improved compared with those before operation, the scores of VAS and ODI in the two groups were 2.50 卤1.30) and 50.00 卤3.50, respectively, and the scores of VAS and ODI in the percutaneous group were 3.00 卤1.50 and 58.00 卤4.50, respectively. The difference between the two groups was statistically significant (P 0.05). The improvement rate of clinical symptoms was 73.33 and 80.00.The position of the screw was well located, the lesion segment was fused well, and no screw loosened. The position deviation of the screw in the percutaneous group was 3.57). Conclusion the accuracy and safety of pedicle assisted screw placement in the treatment of LDD is higher than that of traditional percutaneous nail, and the operation time is shorter and the bleeding is less.
【作者单位】： 广州医科大学附属第五医院骨科;广州医科大学附属第一医院脊柱外科/广州骨科研究所;
【基金】：广东省科技计划项目(2014A020212369)
【分类号】：R687.3
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本文编号：1518277