后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳_《中国修复重建外科杂志》

作者：

魏富鑫 , 刘少喻 , 崔尚斌 , 王乐 , 梁春祥 , 龙厚清 , 黄阳亮

中山大学附属第一医院脊柱外科（广州，510700）;

关键词：

退行性腰椎失稳后路腰椎椎间融合术椎弓根钉内固定

DOI：

10.7507/1002-1892.20130155

视频：

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目的评价后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳的临床疗效。方法2008年2月－2011年12月，采用后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳患者33例。男20例，女13例；年龄39～75岁，平均47.2岁。病程6～25个月，平均12.8个月。腰椎间盘突出伴失稳14例，腰椎管狭窄伴失稳15例，腰椎间盘髓核摘除术后1年复发3例，极外侧型腰椎间盘突出症1例。单节段固定28例，其中L4、 5 21例，L5、S1 6例，L5、6 1例（骶椎腰化患者）；双节段固定5例，均为L3、4、L4、5。根据Oswestry功能障碍指数（ODI）及改良下腰痛日本骨科协会（JOA）评分评价手术疗效。结果术后1例发生切口感染，经换药后愈合；其余患者切口均Ⅰ期愈合。31例获随访，随访时间15～53个月，平均32.3个月。除1例因术后Cage移位改行双侧椎弓根钉固定外，其余患者均未发生断钉、Cage移位或椎间假关节形成等并发症。X线片示除1例Cage移位导致植骨融合失败外，余均达椎间骨性愈合。末次随访时ODI及JOA评分均较术前及术后2周评分显著改善（P lt; 0.05）；ODI和JOA评分改善率分别为74.0% ± 10.1%和83.6% ± 9.4%。结论后路单侧椎弓根钉固定联合椎间融合术能简化手术操作，减小创伤，是治疗退行性腰椎失稳的有效方法之一。

引用本文： 魏富鑫,刘少喻,崔尚斌,王乐,梁春祥,龙厚清,黄阳亮. 后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳. 中国修复重建外科杂志, 2013, 27(6): 703-707. doi: 10.7507/1002-1892.20130155 复制

1.	朱云荣, 叶晓健, 蒋玉权, 等. 改良腰椎后路椎间植骨单侧椎弓根螺钉固定在腰椎融合手术中的应用. 第二军医大学学报, 2010, 31(10): 1095-1099.
2.	王生介, 厉晓龙, 夏才伟, 等. 髓核摘除单侧内固定椎间融合术治疗腰椎间盘突出症早期疗效. 中国脊柱脊髓杂志, 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, Oğün 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.	孙兵, 车晓明. 日本骨科协会评估治疗(JOA评分). 中华神经外科杂志, 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.	陈家麟, 茅祖斌, 吴小涛. 四种经椎间孔腰椎间融合固定方式的三维有限元分析. 中国组织工程研究与临床康复, 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.	杨群, 吕德成, 姜长明, 等. 单枚 cage 单侧椎弓根螺钉内固定术治疗退行性腰椎不稳. 中国脊柱脊髓杂志, 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. 朱云荣, 叶晓健, 蒋玉权, 等. 改良腰椎后路椎间植骨单侧椎弓根螺钉固定在腰椎融合手术中的应用. 第二军医大学学报, 2010, 31(10): 1095-1099.
2. 王生介, 厉晓龙, 夏才伟, 等. 髓核摘除单侧内固定椎间融合术治疗腰椎间盘突出症早期疗效. 中国脊柱脊髓杂志, 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, Oğün 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. 孙兵, 车晓明. 日本骨科协会评估治疗(JOA评分). 中华神经外科杂志, 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. 陈家麟, 茅祖斌, 吴小涛. 四种经椎间孔腰椎间融合固定方式的三维有限元分析. 中国组织工程研究与临床康复, 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. 杨群, 吕德成, 姜长明, 等. 单枚 cage 单侧椎弓根螺钉内固定术治疗退行性腰椎不稳. 中国脊柱脊髓杂志, 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.

《中国修复重建外科杂志》

后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳

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《中国修复重建外科杂志》

后路单侧椎弓根钉固定联合椎间融合术治疗退行性腰椎失稳

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