椎间植骨融合术联合关节突螺钉瞄准器治疗老年腰椎间盘突出症合并腰椎骨折

目的分析椎间植骨融合术联合关节突螺钉瞄准器治疗老年腰椎间盘突出症合并腰椎骨折的临床效果。方法选择2014年6月—2016年6月南京中医药大学附属南京市中西医结合医院收治的140例腰椎间盘突出合并腰椎骨折的老年患者,根据治疗方案不同分为对照组和观察组各70例。对照组男性40例,女性30例;平均年龄(69.5±6.7)岁。观察组男性38例,女性32例;平均年龄(70.4±5.9)岁。对照组选择椎间植骨融合术联合常规椎弓根螺钉系统固定术治疗,观察组选择椎间植骨融合术联合关节突螺钉瞄准器治疗,比较两组切口长度、手术时间、术中出血量和切口引流量,术后48h的疼痛程度,术前、术后及随访12个月的椎间隙高度及螺钉位置、围术期并发症发生率。结果两组切口长度、手术时间、术中出血量和切口引流量比较差异无统计学意义[(4.8±0.6)cm vs.(4.7±0.9)cm,(124.6±35.7)min vs.(132.4±42.5)min,(215.9±42.3)m L vs.(242.3±52.7)m L,(352.8±76.5)m L vs.(389.6±85.7)m L]。观察组术后48h疼痛视觉模拟评分(VAS)显著低于对照组[(3.5±0.8)vs.(4.8±1.3),P=0.028]。术后两组椎间隙高度明显增加,随访12个月椎间隙高度较术后减小,观察组术后和随访高度均显著大于对照组[(11.2±2.4)mm vs.(10.5±2.2)mm,P=0.036;(10.9±2.6)mm vs.(9.2±2.5)mm,P=0.031]。观察组螺钉位置I型比例显著高于对照组(90.0%vs.75.7%,P=0.025)。观察组手术并发症发生率显著低于对照组(5.7%vs.17.1%,P=0.034),随访12个月椎间融合及椎体稳定性显著高于对照组(92.9%vs.80.0%,P=0.026),JOA评分改善率显著高于对照组[(87.8±7.9)%vs.(56.9±13.2)%,P=0.000]。结论椎间植骨融合术联合关节突螺钉瞄准器治疗老年腰椎间盘突出合并腰椎骨折有较好的临床效果。

Application of intervertebral fusion combined with transarticular screw sighting device in treating elderly patients with lumbar intervertebral disc herniation combined with lumbar fracture

Objective To study the effect of intervertebral fusion combined with transarticular screw sigh-ting device in treatment of elderly patients with lumbar intervertebral disc herniation combined with lumbar fracture . Methods A total of 140 elderly patients with lumbar intervertebral disc herniation combined with lumbar fracture enrolled into our hospital from Jun .2014 to Jun.2016 were collected as our study subjects and divided into 2 groups.Seventy cases in the control group underwent intervertebral fusion combined with conventional pedicle screw system fixation and 70 cases in the observation underwent intervertebral fusion combined with transarticular screw sighting device.The short and long term effects were recorded and compared within 2 groups.Results The inci-sion length, operation time, blood loss during operation and drainage volume after operation in the two groups had no statistical difference[(4.8 ±0.6) cm vs.(4.7 ±0.9) cm,(124.6 ±35.7) min vs.(132.4 ±42.5) min, (215.9 ±42.3) mL vs.(242.3 ±52.7) mL, (352.8 ±76.5)mL vs.(389.6 ±85.7) mL] (P<0.05).The VAS at 48 h after operation in the observation group was significantly decreased [(3.5 ±0.8) vs.(4.8 ±1.3), P=0.028].The disc height after operation was increased , then decreased in 12 months than after operation in the two groups(P<0.05).Compared with the control group , the disc height after operation and at 12 months of follow-up was increased in the observation group [(11.2 ±2.4) mm vs.(10.5 ±2.2) mm.P=0.036; (10.9 ±2.6) mm vs.(9.2 ±2.5) mm, P=0.031].Compared with the control group, the cases of screw position type I was in-creased in the observation group (90.0%vs.75.7%, P=0.025).Compared with the control group , the cases of the complications in the observation group was decreased (5.7%vs.17.1%,P=0.034), the rate of vertebral fu- sion and stability was higher (92.9%vs.80.0%,P=0.026), and the improvement rate of JOA score was higher [(87.8 ±7.9)%vs.(56.9 ±13.2)%, P=0.000].Conclusion Intervertebral fusion combined with transar-ticular screw sighting device can be used in treatment of elderly patients with lumbar intervertebral disc herniation combined with lumbar fracture .