椎板关节突螺钉两种不同置钉方法的临床对比研究

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (5): 581-584.

椎板关节突螺钉两种不同置钉方法的临床对比研究

曾忠友，　陈国军，　汤永华，　严卫峰，　吴　鹏，　张建乔

武警部队骨科医学中心，武警浙江省总队医院骨二科，浙江嘉兴 314000

收稿日期:2010-12-01 出版日期:2011-09-25 发布日期:2011-09-29
作者简介:曾忠友（1969-），男，江西进贤人，医学硕士，研究方向：脊柱和关节疾病的外科治疗
基金资助:
浙江省卫生厅科研项目资助(2010KYB112)

The comparision of two methods for placing translamina facet screw

ZENG Zhong-you, CHEN Guo-jun, TANG Yong-hua, YAN Wei-feng, WU Peng, ZHANG Jian-qiao

The Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Armed Police Forces, Zhejiang, Jiaxing 314000, China

Received:2010-12-01 Online:2011-09-25 Published:2011-09-29

摘要/Abstract

摘要：

目的　比较椎板关节突螺钉两种不同置钉方法的优缺点。方法　回顾性分析2006年8月～2008年6月，采用椎板关节突螺钉固定联合椎间融合器植骨治疗单节段下腰椎病变47例，其中开放置钉21例，瞄准器引导下经皮置钉26例。两组病例在性别、年龄、病史时间、疾病类型、病变部位、疾病严重程度方面无统计学差异。结果　两组病例均顺利完成手术，均未输血，术中、术后未出现相关并发症。两组病例术中导针穿刺次数、切口长度、手术时间、术中出血量、术后切口引流液量和术后螺钉位置相比差异有统计学意义（P＜0.05）；两组病例均获随访，随访时间12～36个月，平均19个月，两组病例融合率无差异。随访过程中两组病例均未出现螺钉松动、移位、断裂等现象，亦未出现椎间融合器移位现象，最后随访时两组JOA评分改善率相比差异无统计学意义（P＞0.05）。结论　与开放置钉相比，瞄准器引导下经皮置钉具有创作小、操作简单、准确性和安全性高等优点，同时缩短了手术时间，因此，瞄准器可作为腰椎椎板关节突螺钉置钉的较好选择。

关键词: 椎板关节突螺钉, 固定, 瞄准器, 经皮, 下腰椎

Abstract:

Objective　To compare advantage and disadvantage of two different methods for placing the translamina facet screw.　Methods　The study reviewed 47 patients of low lumbar vertebra diseases underwent the surgery. 21 cases were placed screw by opening procedure, the others were placed screw by the percutanous gunsight guiding. There was no difference among the gender, age, history time, diseased type, diseased region and severity in two groups.　Results　All cases underwent the surgery successfully, with no complication occurred intraoperatively and postoperatively. There was significant differences among the times of intraoperative guide pin puncture, length of incision, operative time, intraoperative bleeding, postoperative incisal draining and postoperative screws location in two sets. All cases were followed-up for 12 to 36 months, averagely 19 months. 44 cases got bony fusion, only 3 suffered from poor bony fusion. Improving rate of the JOA grades was insignificant different in two sets.　Conclusions　Compared to that of opening fixation, the screw placing through percutanous gunsight guiding is more prevalent, such as the small surgery trauma, simple operation, high intraoperational safety, and short manipulation time. Therefore, gunsight is a good choice for translamina facet screw fixation.

Key words: Lamina facet screw, Fixation, gunsight, Percutanous, Low lumbar vertebrae

中图分类号:

R683.2

曾忠友, 陈国军, 汤永华, 严卫峰, 吴鹏, 张建乔. 椎板关节突螺钉两种不同置钉方法的临床对比研究[J]. 中国临床解剖学杂志, 2011, 29(5): 581-584.

CENG Zhong-You, CHEN Guo-Jun, SHANG Yong-Hua, YAN Wei-Feng, TUN Feng, ZHANG Jian-Jiao. The comparision of two methods for placing translamina facet screw[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(5): 581-584.

参考文献

[1] Humke T, Grob D, Dvorak J, et al.Translaminar screw fixation of the lumbar and lumbosacral spine. A 5-year follow-up
[J]. Spine, 1998, 23(10):1180-1184.

[2] Aepli M, Mannion AF, Grob D. Translaminar screw fixation of the lumbar spine:long-term outcome
[J].Spine,2009,34(14):1492-1498.

[3] Pavlov PW, Meijers H, van Limbeek J,et al. Good outcome and restoration of lordosis after anterior lumbar interbody fusion with additional posterior fixation
[J]. Spine, 2004, 29(17):1893-1899.

[4] Shim CS, Lee SH, Jung B, et al. Fluoroscopically assisted percutaneous translaminar facet screw fixation following anterior lumbar interbody fusion: technical report
[J]. Spine, 2005, 30(7):838-843.

[5] Kang HY, Lee SH, Jeon SH, et al. Computed tomography-guided percutaneous facet screw fixation in the lumbar spine. Technical note
[J]. J Neurosurg Spine, 2007, 7(1):95-98.

[6] 曾忠友，江春宇，张建乔，等．腰椎椎板关节突螺钉瞄准器的研制
[J]．中国骨与关节损伤杂志，2009，24(4)：761-762．

[7] 曾忠友，江春宇，宋永兴，等．下腰椎椎板、关节突的影像学测量与临床意义
[J]．中国临床解剖学杂志，2009，27(4)：420-422、425．

[8] Heggeness MH, Esses SI. Translaminar facet joint screw fixation for lumbar and lumbosacral fusion. A clinical and biomechanical study
[J]. Spine,1991,16(6 Suppl):S266-269.

[9] Kandziora F, Schleicher P, Scholz M, et al.Biomechanical testing of the lumbar facet interference screw
[J]. Spine, 2005,30(2):E34-39.

[10] Jang JS,Lee SH,Lim SR.Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion. Technical note
[J]. Neurosurg, 2003, 98(1 Suppl):100-103.

[11] 曾忠友，张建乔，严卫锋，等.椎板关节突螺钉瞄准器在治疗下腰椎退行性病变的临床应用
[J].中国矫形外科杂志，2011，19（5）：378-381．

[12] 曹鹏，吴华成，张伟滨，等．腰椎后路术后骶棘肌损伤的实验研究
[J]．中华创伤骨科杂志，2004，6(2)：202-206.

[13]Motosuneya T, Asazuma T, Tsuji T, et al. Postoperative change of the cross-sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging
[J]. J Spinal Disord Tech, 2006, 19(5):318-322.

[14]Hyun SJ, Kim YB, Kim YS, et al. Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion
[J]. J Korean Med Sci, 2007, 22(4):646-651.

[15]Harris BM, Hilibrand AS, Savas PE, et al. Transforaminal lumbar interbody fusion: the effect of various instrumentation techniques on the flexibility of the lumbar spine
[J]. Spine, 2004, 29(4):E65-70.