组配型横突拉钩的研制与临床应用

目的研制组配型横突拉钩并探讨其临床应用效果。方法通过腰椎骨骼标本和腰部软组织的观察、测量,设计制作了以腰椎横突为固定支点的组配型拉钩,将其应用于单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定并椎间融合植骨的手术方式,并与传统椎板拉钩的使用进行比较。对比2组病例手术时间、术中出血量、术后切口引流液量、切口长度、术后72 h腰部切口疼痛视觉模拟量表(visual analogue scale,VAS)评分。采用日本骨科学会(Japanese Orthopaedic Association,JOA)下腰痛评分法对临床效果进行评价和对比。结果在手术时间、术中出血量和切口长度方面,组配型横突拉钩组优于椎板拉钩组,差异有统计学意义(P0.05);而在术后切口引流液量、术后72 h腰部切口疼痛VAS评分及最后随访JOA评分方面2组相比差异无统计学意义(P0.05)。结论与传统椎板拉钩相比,组配型横突拉钩具有容积小、组装方便、把持性好、固定确切、视野大、对手术操作干扰小以及适合人群和手术方式广泛等优点,可作为腰椎后路内固定手术的显露工具。

Clinical application and manufacture of matched lumbar transverse process retractor device

Objective To manufacture a matched lumbar transverse process retractor device and investigate its effects in internal fixation of lumbar vertebrae by posterior approach. Methods Based on the skeletal specimens of the lumbar vertebrae and the lumbar soft tissue thickness, a surgical retractor device was designed. The device took lumbar transverse process as a fixed pivot and was equipped with matched retractors of different functions. It worked to help treatment of lumbar vertebrae diseases by unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation by percutaneou as well as posterior lumbar interbody fusion. Operation time, intraoperative blood loss, postoperative wound drainage, incision length and pain visual analogue scale(VAS) scores at postoperative 72 h were compared between conventional lamina retractor device (conventional retractor group) and the matched lumbar transverse process retractor device (new retractor group). The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the patient's symptoms, physical sign, daily activities and bladder function after treatments in the 2 groups. Results No wound skin necrosis or infection occurred in each group. Compared to conventional retractor group, operation time and incision length was shorter and intraoperative blood loss was less in new retractor group(P<0.05). There were no significant differences in postoperative wound drainage, VAS scores at postoperative 72 h and the JOA scores between the 2 groups(P>0.05). Conclusion The matched lumbar transverse process retractor device has advantages, including smaller volume, easier to assemble and to install, greater holding capacity, more precise fixation position, larger visual field, fewer interventions to operation, more suitable to humans, and available for more surgical methods over conventional lamia retractor device, and therefore is a promising surgical device for internal fixation of lumbar vertebrae by posterior approach.