S2骶岬螺钉技术辅助增强固定在腰骶椎翻修术中的应用

目的探讨S_2骶岬螺钉(S_2-alar screw,S_2-AS)在腰骶椎翻修术中的效果和意义。方法 2011年6月—2014年5月,7例腰骶椎内固定失败患者在本院接受骶骨侧的S_2-AS技术增强固定。记录手术时间、出血量及相关并发症,评估腰骶椎的融合效果,并对翻修术前、术后及末次随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)进行对比分析。结果所有手术顺利完成,术后随访12~36个月,平均18个月。手术时间为180~300 min,平均240 min;出血量450~800 m L,平均614 m L,未出现与S_2-AS相关的并发症。末次随访时无内固定物失败的情况出现,并达到骨性融合或可能融合标准。术前、术后及末次随访时VAS评分分别为(6.86±1.07)分、(1.85±1.10)分和(1.57±0.87)分,术前与术后相比,差异具有统计学意义(P0.01);术前、术后及末次随访时ODI分别为(28.29±7.61)%、(8.57±2.64)%和(7.29±2.43)%,术前与术后相比,差异具有统计学意义(P0.05);且在随访期间有进一步改善趋势。结论 S_2-AS是一种安全有效的增加骶骨侧锚定点的外科技术,能对腰骶椎翻修术时S1椎弓根螺钉固定起到辅助增强作用,从而有助于腰骶椎达到骨性融合。

S2-Alar screw auxiliary enhancement in lumbosacral spinal revision surgery

Objective To explore the effect of S₂-alar screw(S₂-AS) in lumbosacral spinal revision surgery.Methods From June 2011 to May 2014, due to failed previous lumboarcal spinal surgery, 7 patients accepted revision with S₂-AS to enhance the anchoring strength at sacral side.The operation time, blood loss and the complications relative to S₂-AS were recorded in the study retrospectively.The outcome of fusion at the level of L₅/S₁ was also evaluated.The visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation, post-operation and the final follow-up were recorded respectively.Results All cases were operated successfully.All cases were followed-up for 12-36 months, mean 18 months.The operation time was 180-300 min, mean 240 min.The blood loss was 450-800 mL, mean 614 mL.No complications relative to S₂-AS were found.The VAS scores at pre-operation, post-operation and the final follow-up were 6.86±1.07, 1.85±1.10 and 1.57±0.87, respectively.The difference of the VAS scores between pre-revision and post-revision was statistically significant(P<0.01).The ODI at pre-operation, post-operation and the final follow-up were(28.29±7.61)%,(8.57±2.64)% and(7.29±2.43)%, respectively.The difference of the ODI between pre-revision and post-revision was statistically significant(P<0.01).Further improvement of ODI could be found during the follow-up.The difference of the ODI between post-revision and the final follow-up was statistically significant(P<0.05).Conclusions The technique of S₂-AS is safe and effective in enhancing the anchoring strength at sacral side during lumbosacral fusion surgery.The anchoring force of S₂-AS can prevent the weak S₁ pedicle screws from failure in the situation of lumbosacral spine revision, and it is helpful for improving the fusion of L₅/S₁ level.