摘要
背景:肌间隙入路通道已成为腰椎固定融合应用较多的手术入路和显露方式,单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合器植骨术是一种独立、有效的固定融合方式,而术中终板损伤时有发生。目的:探讨肌间隙入路通道显露下单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合治疗腰椎病变术中终板损伤的特点和原因,总结终板损伤的处理方式与临床结果。方法:回顾性分析2012年6月至2017年12月采用此手术方式治疗腰椎病变术中出现终板损伤的17例患者。男4例,女13例;年龄44~73岁,平均(61.3±7.4)岁;单节段固定13例,两节段固定4例。单一终板损伤15例,融合节段上下终板均发生损伤2例。观察其临床和影像结果,以及并发症情况。结果:术中无椎弓根骨折、硬脊膜损伤,术中、术后无脑脊液漏和神经损伤,术后无切口感染。随访12~72个月,平均(38.2±15.3)个月。病变节段椎间隙高度均恢复良好,但随访中出现较为明显的丢失,末次随访时与术后对比有统计学意义。融合器均有沉降,2例融合器向后移位。末次随访时除1例不能明确外,均获得椎间融合,融合率94.1%。融合时间12~24个月,平均(16.8±2.8)个月。未发现内固定松动、移位、断裂及固定部位邻近节段的明显退变。结论:肌间隙入路通道显露下单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合治疗腰椎病变无法避免终板的损伤,损伤原因包括:患者骨量减少或骨质疏松、操作因素、香蕉型融合器的应用。只要处理得当,终板损伤并不影响预后,亦未增加内固定松动或断裂、椎间不融合等并发症。但可能加速椎间隙高度丢失,增加融合器沉降,需要加强终板损伤的处理和预防。
Background:Muscle-splitting approach is a common surgical approach in lumbar fixation and fusion.Unilateral pedicle screw combined with contralateral translaminar facet screw fixation is an independent and effective fixation.However,endplate injury sometimes occurs during the procedure.Objective:To investigate the characteristics and causes of endplate injury in the operation of unilateral pedicle screw combined with contralateral translaminar facet screw fixation by muscle-splitting approach,and summarize the management and clinical results of endplate injury.Methods:A retrospective analysis was performed in 17 patients with endplate injury who were treated with this surgical method from June 2012 to December 2017.There were 4 males and 13 females with a mean age of(61.3±7.4)years(range,44-73).One segment was fixed in 13 patients and two segments were fixed in 4 patients.There were 15 cases of single endplate injury of the fusion segment and 2 cases of upper and lower endplate injuries.Clinical and imaging results and complications were observed.Results:There was no pedicle fractures,spinal dura mater injury,or nerve injury during operation.No cerebrospinal fluid leakage or incision infection occurred.The mean follow-up time was(38.2±15.3)months(range,12-72 months).The intervertebral height of diseased segment was well recovered,but there was significant loss during follow-up.There was significant difference in the intervertebral height of diseased segment between preoperatively and at the last follow-up.The cage shifted backwards in 2 cases.Except one,the remaining had well interbody fusion,with the fusion rate of 94.1%.The mean fusion time was(16.8±2.8)months(range,12-24 months).No loosening,displacement,breakage,or obvious degeneration of the adjacent segment was observed.Conclusions:Unilateral pedicle screw combined with contralateral translaminar facet screw fixation by muscle-splitting approach cannot avoid endplate injury.Injury causes include osteopenia or osteoporosis,operating factors,and application of banana-type cages.As long as it is handled properly,endplate injury does not affect prognosis,nor does it increase complications such as internal fixation loosening or rupture,intervertebral nonfusion.However,it may accelerate the loss of intervertebral height and increase cage settlement.Thus,it is necessary to strengthen the management and prevention of endplate injury.
作者
曾忠友
俞伟
张建乔
宋永兴
范时洋
籍剑飞
裴斐
金辉
宋国浩
ZENG Zhongyou;YU Wei;ZHANG Jianqiao;SONG Yongxing;FAN Shiyang;JI Jianfei;PEI Wen;JIN Hui;SONG Guohao(The Second Deptment of Orthopaedics,Hospital of Coast Guard General Corps of Armed Police Forces,Jiaxing 314000,Zhejiang,China)
出处
《中华骨与关节外科杂志》
2020年第10期806-812,共7页
Chinese Journal of Bone and Joint Surgery
