目的 分析肌间隙入路通道下双侧椎弓根螺钉固定并椎间融合治疗单节段或两节段腰椎病变手术并发症的特点和原因。方法 选择2012-06至2019-06海警医院骨科收治的采用肌间隙入路通道下双侧椎弓根螺钉固定并椎间融合器植骨术的506例腰椎病变患者资料。观察病例临床结果、影像结果和并发症情况。结果 病例失访11例,495例获6～84个月随访。最后随访时均获得良好的恢复效果,腰椎冠状面和腰椎矢状面Cobb角有明显改善,与术前对比均有统计学差异(P＜0.05)。并发症脑脊液漏7例(1.38%);椎弓根入点骨折11例(2.17%),发生于单节段4例,两节段7例;终板损伤15例(2.96%),其中发生于骨量减少或骨质疏松病例9例,发生于使用香蕉型融合器病例5例,其他1例;术后切口问题10例(1.98%),其中切口局部皮肤坏死6例,切口愈合不良3例,切口深部感染1例;神经根损伤5例(1%),3例考虑为椎弓根螺钉位置不正确所致,2例考虑术中操作所致;融合器向后移位2例(0.40%);再手术4例(0.78%),包括3例内固定调整及1例切口深部感染。共发生并发症54例(9.88%)。结论 后方肌间隙入路通道下双侧椎弓根螺钉固定并椎间融合器植骨是治疗单节段或两节段腰椎病变的有效方案,开展手术早期,需要重视并预防并发症发生。
Abstract
Objective To investigate the features and causes of complications of single or two-level lumbar lesions treated with bilateral pedicle screw fixation and interbody fusion under intermuscular approach.Methods Retrospective analysis was performed on 506 patients with lumbar vertebra diseases who underwent bilateral pedicle screw fixation and interbody fusion implant bone grafting in Coast Guard Hospital from June 2012 to June 2019. The clinical results, imaging results and complication were observed.Results Eleven cases were lost in the follow-up, and 495 cases were followed up for 6-84 months, with an average of (35.76±16.82) months. At the final follow-up, the VAS scores and ODI indexes of lumbago were well recovered, and the Cobb angle of coronal and sagittal lumbar spine was significantly improved, with statistical differences(P＜0.05)compared with the preoperative results. Complications were as follows, cerebrospinal fluid leakage appeared in 7 cases (1.38%); pedicle entry point fracture occurred in 11 cases (2.17%), with single level in 4 cases and two-level in 7 cases. End plate injury occurred in 15 cases (2.96%), of which 9 cases were caused by bone loss or osteoporosis, 5 cases were caused by banana fusion device, and 1 other case. There were 10 cases (1.98%) of incision problems, including 6 cases of local skin necrosis, 3 cases of poor incision healing, and 1 case of deep incision infection. In 5 cases (1%), 3 cases were considered to be due to incorrect pedicle screw position, and 2 cases were considered to be due to intraoperative manipulation. Two cases (0.40%) had the fusion device shifted backward. Four cases (0.78%) underwent reoperation, including 3 cases of internal fixation adjustment and 1 case of deep incision infection. A total of 54 complications occurred (9.88%).Conclusions Bilateral pedicle screw fixation with interbody fusion graft under posterior intermuscular space approach has good clinical effect and many clinical advantages in the treatment of single or two-level lumbar diseases, but there are also complications, especially in the early stage of development, which need to be prevented.
关键词
腰椎 /
脊柱融合术 /
内固定器 /
微创 /
并发症
Key words
lumbar spine /
spinal fusion /
internal fixator /
minimally invasive /
complication
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参考文献
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