摘要
目的采用微创方法减小置入腰椎椎弓根钉时造成的手术创伤,减少出血,提高手术质量和效果。方法采用定位针导航法,腰椎长短肌肌间隙入路等综合微创方法进行椎弓根置钉并观察效果。结果 2008年9月～2011年4月,采用上述置钉方法,为231例腰椎手术患者进行椎弓根置钉978枚,947枚不用仪器监视,一次性正确置入。31枚需先置入椎弓根定位针,经X线透视确定位置、方向后再置钉,术后全部患者得到CT复查,发现有12枚椎弓根钉发生椎弓根切割穿透,2例发生神经根刺激征,无节段误置,根外置钉。置钉时不用剥离椎旁肌,出血少,对腰肌损伤显著减轻。置钉技术简易化。术后患者创伤反应减轻,恢复时间缩短,腰痛发生率显著降低。结论综合多种微创方法进行椎弓根置钉,可使手术对腰肌损伤明显减轻,出血减少,置钉正确率提高,手术微创化,临床疗效提高。
Objective To reduce the surgical trauma caused by placing the lumbar pedicle screw,reduce bleeding and improve the quality and effectiveness of surgery. Methods The pedicle screw placement was conducted using the positioning needle navigation method,lumbar vertebral long and short muscle intermuscalar space approach and other minimally invasive methods and the effects were observed. Results From September 2008 to April 2011,978 pedicle screws were placed for 231 patients receiving lumbar spine surgery using the above methods,of which 947 screws were placed correctly the first time without instrument monitoring.Thirty-one screws required earlier placement of pedicle positioning pin and the X-ray determination of location and direction. All the patients received postoperative CT review, showing that 12 pedicle screws caused pedicle cutting penetration and 2 caused nerve root irritation,without segment misplacement or extrapedicular placement.The screw placement did not require paravertebral muscle peeling,caused less blood loss and reduced the incidence of lumbar pain.The technique of screw placement was simplified.The patients had mild postoperative traumatic reactions,shorter recovery time and significantly reduced incidence of lumbar pain. Conclusion In the placement of pedicle screws,the comprehensive application of several minimally invasive methods can significantly reduce the lumbar muscle injury caused by surgery,reduce bleeding, improve the correct rate of screw placement and improve the clinical effects.
出处
《中国医药科学》
2013年第6期181-182,196,共3页
China Medicine And Pharmacy
关键词
微创
椎弓根
腰椎融合
Minimally invasive
Pedicle
Lumbar fusion
