经皮腰椎椎板关节突螺钉引导器在椎板关节突螺钉植入中应用价值

目的探讨自行设计的经皮腰椎椎板关节突螺钉引导器在椎板关节突螺钉植入中的安全性、准确性及临床应用价值。方法腰椎退变性疾病患者52例,均行椎弓根钉联合对侧椎板关节突螺钉内固定、经椎间孔入路腰椎椎间融合术,根据椎板关节突螺钉植入方式分为引导器植入组25例和徒手植入组27例,比较2组手术时间、术中X线透视次数、术中出血量、术后引流量、椎板关节突螺钉位置优良率及术后并发症发生情况。术后随访观察椎板关节突螺钉有无松动、断裂及椎间融合情况,比较2组术前和末次随访时JOA评分。结果 2组手术均顺利完成,引导器植入组手术时间(74.33±10.13)min]短于徒手植入组(97.53±17.34)min](P<0.05),术中X线透视次数(6.80±1.52)次]少于徒手植入组(8.60±1.59)次](P<0.05),椎板关节突螺钉位置优良率(88.00%)高于徒手植入组(55.56%)(P<0.05),术中出血量、术后引流量与徒手植入组比较差异无统计学意义(P>0.05)。2组术后均未发生切口深部感染、椎旁肌血肿形成、脑脊液漏及椎间融合器移位等并发症。术后随访5~12个月,2组均无椎板关节突螺钉松动、断裂等,术后6、12个月时2组患者腰椎CT均提示椎间融合。引导器植入组及徒手植入组患者末次随访时JOA评分(23.20±2.88)、(22.60±2.29)分]均高于术前(12.27±1.75)、(11.93±1.44)分](P<0.05);2组患者术前及末次随访时JOA评分比较差异均无统计学意义(P>0.05)。结论应用经皮腰椎椎板关节突螺钉引导器可减少椎板关节突螺钉植入的手术操作时间,减少患者创伤及放射性损害,提高椎板关节突螺钉植入的准确性。

Application of the percutaneous lumbar facet screw guider in translaminar facet screw implantation

Objective To investigate the security, accuracy and clinical value of self-designed positioning guides of percutaneous lumbar facet screw in translaminar facet screw implantation. Methods Fifty-two patients with lumbar degeneration disease underwent MIS decompression and transforaminal lumbar interbody fusion(MIS-TLIF), pedicle screw combined with contralateral translaminar facet screw fixation. According to the different methods of laminectomy process screw implantation, 52 patients were divided into guide device group(n=25) and freehand implantation group(n=27). The operation time, intraoperative X-ray fluoroscopy frequency, intraoperative blood loss, postoperative drainage volume, translaminar facet screw position fitness, and postoperative complications were compared befween two groups. All patients were followed up to observe the occurrence of loosening or breakage of facet screw as well as the intervertebral fusion. The JOA scores were compared before operation and at the final follow-up between two groups. Results Both two groups completed all operations successfully. The operation time was shorter in guide device group((74.33±10.13) min) than that in freehand implantation group((97.53±17.34) min)(P<0.05). The intraoperative X-ray fluoroscopy frequency was less in guide device group((6.80±1.52) times) than that in freehand implantation group((8.60±1.59) times)(P<0.05). The excellent rate of the placement of the laminar facet screw was higher in guide device group(88.00%) than that in freehand implantation group(55.56%)(P<0.05). There were no significant differences in introperative blood loss and postoperative drainage volume(P>0.05). No complications occurred such as deep wound infection, paravertebral hematoma, cerebrospinal fluid leakage and intervertebral cage displacement in two groups. During 5-to 12-month follow-up, there was no loosening or breakage of facet screw. CT scan of lumbar spine in 6-12 months after operation showed interbody fusion. The JOA scores at the final follow-up were higher in two groups(23.20±2.88, 22.60±2.29) than those before operation(12.27±1.75, 11.93±1.44)(P<0.05). There was no significant difference in JOA scores between two groups before operation and at the final follow-up(P>0.05). Conclusion Percutaneous lumbar facet screw guider can shorten the operation time, reduce the trauma and radiation damage, and improve the accuracy of the implantation.