直视法植入螺钉在腰椎退变性疾病椎弓根螺钉固定的应用

doi:10.13418/j.issn.1001-165x.2018.06.018

Abstract

Abstract:

Objective　To investigate the application effect of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation.　Methods　120 patients with lumbar degenerative disease were treated with pedicle screw fixation by an open posterior approach. According to the placement method of pedicle screw, they were divided into group A with 80 cases using the traditional method adopting the crista lambdoidalis as anatomical marker for screw placement (group A, 80 cases), and group B with 40 cases using the media-inferior edge of the pedicle as the anatomical landmark for screw placement under direct vision after laminectomy or fenestration as anatomical mark. There was no statistically significant difference in general data between the two groups (P>0.05). The fluoroscopy time, placement time of pedicle screw, intraoperative blood loss, position of screw, fusion rate, functionary recovery (JOA score) and incidence of complications were recorded and compared between the two groups.　Results　The fluoroscopy time, placement time, intraoperative blood loss and the position of screw in group B were less or better than those in group A, and the differences were statistically significant (P<0.05); the functional recovery and complications in group B were better than those in group A, but the differences were not statistically significant (P>0.05); the fusion rate was 100% in both groups.　Conclusions　The method of pedicle screw placed under direct vision is simple and effective, which can be used as a supplement to traditional methods in some cases for degenerative diseases of lumbar spine.

Key words: , Pedicle screw；　Degenerative lumbar disease；　Placement method of screw

YIN Qu-dong, GU San-jun, SUN Zhen-zhong, SONG Shen, ZHOU Zi-hong, CHEN Li. Application of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(6): 690-693.

References

[1] 冯运垒, 李立新, 徐达传. 椎弓根螺钉进钉方法的研究现状[J]. 中国临床解剖学杂志, 2003, 21(6):642-643.
[2] 姚辉, 徐义春, 侯刚, 等. 经后路减压椎弓根钉棒内固定椎间融合治疗高龄腰椎退行性疾病的疗效[J].中国老年学杂志, 2016, 36(22): 5726-5728.
[3] 刘健, 周初松, 靳安民, 等. 椎弓根螺钉内固定加植骨融合治疗腰椎滑脱[J]. 中国临床解剖学杂志, 2006, 24(6): 698-699.
[4] 曾忠友, 严卫锋, 唐宏超, 等. 腰椎椎弓峡部裂伴椎体Ⅱ°或以上滑脱的手术治疗策略[J]. 中国临床解剖学杂志, 2013, 31(5): 591-595.
[5] 朱余龙, 朱海涛, 王水. 腰椎退变性疾病行椎弓根螺钉内固定医源性失误10例原因分析[J]. 交通医学, 2010, 24(6): 685-687.
[6] Groff MW, Dailey AT, Ghogawala Z, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion[J]. Neurosurg Spine, 2014, 21(1): 75-78.
[7] Saarenpää I, Laine T，Hirvonen J，et al. Accuracy of 837 pedicle screw positions in degenerative lumbar spine with conventional open surgery evaluated by computed tomography[J]. Acta Neurochirurgica，2017,159(10):2011-2017.
[8] 杜心如, 叶启彬, 赵玲秀, 等. 腰椎人字嵴顶点椎弓根螺钉进钉方法的解剖学研究[J]. 中国临床解剖学杂志, 2002, 20(2):86-88.
[9] 陈德玉, 袁文, 陈宇, 等. 退变性腰椎侧凸患者椎弓根解剖变化与椎弓根螺钉置入安全性观察[J]. 中华外科杂志, 2008, 46(22):1752-1753.
[10]殷渠东, 郑祖根, 董启榕, 等. 椎弓根螺钉位置与手术效果的关系[J].中国矫形外科杂志, 2000, 7(4): 408-409.
[11]纪忠义. 腰椎椎弓根螺钉置钉位置欠佳的原因分析[J]. 中国中医骨伤科杂志, 2014, 22(2): 58-59.
[12]殷渠东, 郑祖根. 椎弓根螺钉位置与手术效果的关系[J]. 中国矫形外科杂志, 2000, 7(4): 408-409.
[13] 殷渠东, 郑祖根, 蔡建平, 等. 对X线图像评价椎弓根螺钉水平面位置的探讨[J]. 中国脊柱脊髓杂志, 2003,13(5):300-303.
[14] 姚欣强,程勇泉,郑明辉,等.不同节段腰椎峡部裂对腰椎间盘退变程度的影响[J].中国矫形外科杂志, 2017, 25(9):785-789.
[15]周立娟, 孙静华, 李立超. 腰椎关节角在腰椎退变过程中的改变及临床意义[J]. 中国煤炭工业医学杂志, 2003, 6(8): 716.
[16]吕昕, 张斌, 刘远, 等.下腰椎小关节退变与脊柱-骨盆矢状面平衡的相关性研究[J]. 中国修复重建外科杂志, 2015, 29(8): 964-968.
[17]张亚峰, 王建伟, 蔡建平, 等. 胸腰椎椎弓根螺钉置入位置不当19例分析[J]. 中国组织工程研究与临床康复, 2009,13( 39): 7773-7776.
[18]颜冰珊, 尹望平, 倪妙忠, 等. CT三维重建评价椎弓根螺钉位置分级的可信度分析[J]. 中国组织工程研究, 2015,19(44):7172-7176.
[19]Tian NF, Huang QS, Zhou P, et al. Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies[J].European Spine,2011, 20(6): 846–859.
[20]Resnick DK, Watters WC, Mummaneni PV, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 10:lumbar fusion for stenosis without spondylolisthesis[J]. J Neurosurg Spine, 2014, 21(1): 62-66.

Application of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Jiang Jianhong, Duan Renpeng, Li Xiaofeng. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 1-4.
[2]	Guo Hongzhi, Wang Yu, Zhang Jiaqi, Liang Haibin, Ma Ziwei, Feng Wei, Wu You, Si Ziyi. Evaluation of placental vascular structure in preeclampsia by vascular casting combined with CT three-dimensional model [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 5-10.
[3]	Li Jiawei, Zhang Jing, Li Canran, Lan Wenjie, Ji Qingyu, Guo Zhiyong, Zhang Yunfeng, Liu Qi, Chen Qingwei, Li Xiaohe. X-ray measurement of proximal femur anatomical parameters in Mongolian population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 11-16.
[4]	. Digital measurement and clinical significance of occipitocervical Angle and posterior occipitocervical Angle in children and adolescents [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 17-20.
[5]	Li Wen, Yang Siyi, Huang Lei, Qing Jiwen, Jiang Songtao, Zhang Lei. Morphological characteristics and clinical significance of Lisfranc ligament based on MRI [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 21-25.
[6]	Li Fanfan, Xu Yang, Wang Xiaoxu. Therapeutic effect of shikonin on the treatment of granuloma lobular mastitis in model rats by regulating Nrf2/HO-1 signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 26-32.
[7]	Wang Xinghang, Ding Jiayuan, Li Fang, Bao Cuifen, Yan Lijing. Ginsenoside Rg1 reduces the inflammatory response of microglia after oxygen glucose deprivation/resupply by inhibiting the NLRP3 inflammasome pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 33-41.
[8]	Cheng Yingying, Wu Jianjun, Cai Haiyan , Jiao Xunwen, Ma Jiangbo, Ding Yinxiu. Activation and functional changes of astrocytes cultured in vitro under inflammatory stimulation [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 42-46.
[9]	Qi Zhi, Yang Li, Jia Qiuye, Chen Haolun, Duan Zhaoda, Wu Chunyun. Edaravone regulates Sirt3 expression in lipopolysaccharide-activated microglia via MAPKs signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 47-53.
[10]	Zhang Jingjing, Wang Hongxin. Protective effect of Baicalin on rats with pulmonary hypertension through PDGF/P38 MAPK signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 54-58.
[11]	Yue Qin, Chen Rongli, Xiong Jingxi, Wang Tingyi, Cai Zhiheng, Yi Qiushi, Zeng Xinyi. Effect of Bletilla striata polysaccharides on the choke-area of cross-boundary flap in rats [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 59-64.
[12]	Li Xiaoyu , Zhang Lei , Fu Lei , Li Dongbo , Wang Guoyou. Finite element study on the treatment of Sanders type II calcaneal fracture with three-step reduction method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 65-70.
[13]	Wu Yanfei, Ma Jianxiong, Lu Bin, Wang Ying, Bai Haohao, Jin Hongzhen, Ma Xinlong. Study on the correlation between the reconstruction of grayscale values using CT post-processing technology and the compressive strength of the endplate [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 71-76.
[14]	Zhuang Wanqiang, Tang Yi, Luo Yonggang, Zhang Hui. An early and mid-term retrospective study of the effects of arthroscopy combined with high tibial osteotomy on patellar position and patellofemoral joint function [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 77-82.
[15]	Luo Ying, Dou Weiyu, Wu Xiaohang, Chen Jingkun, Peng Changgui, Pan Jianying . Risk factors of postoperative complications of calcaneal fractures treated with hippocampal plate internal fixation through minimally invasive method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 83-88.