改良Weinstin法在治疗腰椎峡部裂型滑脱中的应用

目的探讨改良Weinstin法在治疗腰椎峡部裂型滑脱中定位置钉点的准确性及临床效果。方法回顾性分析2008年1月至2012年12月期间的186例腰椎峡部裂型滑脱患者,按置针点定位方法分为改良Weinstin组105例,Weinstin组81例。比较两组病例的手术时间、术中和术后出血量、术前及术后3个月的疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)评分、术后相关并发症、置钉准确性。结果改良Weinstin组,手术时间为(118.53±24.34)min,术中出血量为(278.28±85.30)mL,术后出血量为(238.92±90.02)mL;Weinstin组,手术时间为(143.34±32.84)min,术中出血量为(389.83±103.36)mL,术后出血量为(256.21±69.34)mL。两组间手术时间及术中出血量差异均具有统计学意义(均P<0.05),而术后出血量差异无统计学意义(P>0.05);两组术前及术后3个月的VAS及ODI差异均无统计学意义(均P>0.05);两组术后相关并发症及置钉准确性的差异无统计学意义(P>0.05)。结论改良Weinstin法操作简单,术中无需暴露横突,减少了手术时间,降低了术中出血量。

Clinical application of modified Weinstin technique used as pedicle screw placement for lumbar spondylolisthesis

Objective To investigate the effectiveness and reliability of modified Weinstin technique used as pedicle screw placement for lumbar spondylolisthesis. Methods A total of 186 patients of lumbar spondylolisthesis were treated from Jan. 2008 to Dec. 2012. All the patients were divided into two groups: the modified Weinstin technique group and the Weinstin group. The operative duration and intraoperative and postoperative estimated blood loss (EBL) were recorded. The clinical functional outcomes were assessed according to Oswestry disability index (ODI) questionnaire, visual analogue scale (VAS), complications and the accuracy of pedicle screw placement. Results The average operative duration was (118.53±24.34) min in the modified Weinstin technique group and (143.34±32.84) min in the Weinstin group; the average intraoperative EBL was (278.28±85.30) mL in the modified Weinstin technique group and (389.83±103.36) mL in the Weinstin group; the average postoperative EBL was (238.92±90.02) mL in the modified Weinstin technique group and (256.21±69.34) mL in the Weinstin group, respectively (P<0.05 for all). There was no significant difference in postoperative EBL, ODI, VAS, complications and the accuracy of pedicle screw placement between two groups. Conclusion Modified Weinstin technique didn''t have to expose the transverse process during operation. It used as pedicle screw placement has the characteristics of less blood loss and shorter operative time.