Wiltse入路单侧椎弓根...椎峡部裂的疗效及安全性研究_韩亮.pdf
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7、tion in COPD patients J.J For-mos MedAssoc,2019,118(1 Pt 3):429-435.(收稿日期:2022-04-22)Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂的疗效及安全性研究韩亮,李强松武警陕西省总队医院骨科,陕西西安710000【摘要】目的研究Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂的疗效及安全性。方法选取2019年3月至2020年12月期间武警陕西省总队医院收治的80例单节段腰椎峡部裂患者进行研究,根据随机数表法分为观察组和对照组各40例。两组患者均进行自体髂骨移植治疗,对
8、照组采用正中入路单侧椎弓根钉棒内固定,研究组采用Wiltse入路单侧椎弓根钉棒内固定,比较两组患者的住院时间、手术时间、术后引流量、术中出血量等相关手术指标;比较两组患者术前及术后7 d、3个月和末次随访时的日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分;比较两组患者术后Frankel分级评定、椎间融合率、植骨融合时间和并发症发生情况。结果研究组患者术后引流量、术中出血量、手术时间、住院时间分别为(77.911.5)mL、(148.317.5)mL、(2.320.42)h、(8.42.4)d,明显短(少)于对照组的(3.640.51)h、(269.425.4)mL、(1
9、21.417.8)mL、(14.33.1)d,差异有统计学意义(P0.05);术后7 d、术后3个月以及末次随访时,两组患者的JOA评分明显升高、ODI评分明显下降,且研究组患者的JOA评分分别为(15.640.87)分、(22.731.51)分、(24.383.05)分,明显高于对照组的(13.010.52)分、(18.221.03)分、(22.042.61)分,术后ODI评分分别为(19.43.5)%、(11.32.4)%、(8.31.6)%,明显低于对照组的(25.73.7)%、(17.92.8)%、(14.72.1)%,差异均有统计学意义(P0.05),而治疗后末次随访时,研究组患者的
10、脊髓神经功能明显优于对照组,差异有统计学意义(P0.05);研究组患者术后并发症总发生率为5.0%,略高于对照组的2.5%,但差异无统计学意义(P0.05)。结论Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂可有效降低患者术中出血量、术后引流量、术后疼痛感,改善患者术后腰部运动功能,临床疗效显著且安全性高,值得推广应用。【关键词】单节段腰椎峡部裂;Wiltse入路;单侧椎弓根钉棒内固定;自体髂骨移植;疗效;安全性【中图分类号】R681.5+7【文献标识码】A【文章编号】10036350(2023)04051406Efficacy and safety of unila
11、teral pedicle screw rod internal fixation combined with autologous iliac bonetransplantation through Wiltse approach in the treatment of single segment lumbar spondylolysis.HAN Liang,LIQiang-song.Department of Orthopedics,Armed Police Shaanxi Provincial Corps Hospital,Xian 710000,Shaanxi,CHINA【Abstr
12、act】ObjectiveTo study the efficacy and safety of unilateral pedicle screw rod internal fixation com-bined with autologous iliac bone transplantation through Wiltse approach in the treatment of single segment lumbar spon-论著 doi:10.3969/j.issn.1003-6350.2023.04.012第一作者:韩亮(1987),男,主治医师,主要研究方向为骨科。通讯作者:李
13、强松(1982),男,主治医师,主要研究方向为骨科,E-mail:。514Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期腰椎峡部裂是指腰椎一侧或两侧上下关节突之间的峡部骨质不连,患者早期并无明显症状,通常是因腰痛进行影像学检查予以确诊,而随病情发展会出现下肢麻木、疼痛等症状,给患者带来较多不便1-2。发病早期可采取非手术方式达到满意效果,但仍有部分患者则会因顽固性疼痛、进展至腰椎滑脱等原因而选择手术治疗。临床上的手术方法有Buck法、Scott法、椎弓根钉棒内固定法和微创方法等,其中Scott法有着较高的并发症发生率、且植骨融合率较低,目
14、前临床较少使用;Buck法的稳定性低于椎弓根螺钉固定方法和Morscher法,而Morscher法虽然属于微创治疗方法但是缺乏相关的报道3-4。Wiltse入路是一种较为简单的微创技术,在临床被广泛应用于胸腰椎骨折和腰椎退行性疾病的治疗中,但是在腰椎峡部裂的治疗中较少应用5。本研究采用Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂患者,旨在探讨该微创方法在疼痛缓解、临床效果、安全性等方面的效果。1资料与方法1.1一般资料选取2019年3月至2020年12月期间武警陕西省总队医院收治的80例单节段腰椎峡部裂患者进行研究。纳入标准:(1)不同程度下腰痛现象,且采取非手术规
15、范治疗后均无明显缓解者;(2)腰痛症状6个月者;(3)经影像学检验确诊为单节段腰椎峡部裂者。排除标准:(1)腰椎失稳者;(2)腰椎脱落症、腰椎间盘突出症者;(3)伴有其他腰椎病变者;(4)不愿谨遵医嘱,不密切配合的患者。根据随机数表法将患者分为研究组和对照组,每组40例。两组患者的基线资料比较差异均无统计学意义(P0.05),具有可比性,见表1。本研究经我院医学伦理委员会批准,患者及其家属知情并签署知情同意书。1.2手术方法1.2.1对照组该组患者采用正中入路单侧椎dylolysis.MethodsFrom March 2019 to December 2020,80 patients wit
16、h single segment lumbar spondylolysis admit-ted toArmed Police Shaanxi Provincial Corps Hospital were selected for study.According to the method of random num-ber table,the patients were divided into an observation group and a control group,each with 40 patients.Based on autog-enous iliac bone trans
17、plantation,the control group applied unilateral pedicle screw rod internal fixation through the medi-an approach,and the study group applied unilateral pedicle screw rod internal fixation through the Wiltse approach.Thelength of hospital stay,operation time,postoperative drainage volume,intraoperati
18、ve bleeding,and other related surgicalindicators of the patients in the two groups were compared.The Japanese Orthopaedic Association Scores(JOA)and Os-westry dysfunction index(ODI)scores of the two groups were compared before operation,at 7 days,3 months after oper-ation,and at the last follow-up.F
19、rankel grading,intervertebral fusion rate,bone graft fusion time,and complicationswere compared between the two groups.ResultsThe postoperative drainage volume,intraoperative bleeding volume,operation time,and length of hospital stay in the study group were(77.911.5)mL,(148.317.5)mL,(2.320.42)h,and(
20、8.42.4)d,which were significantly shorter(less)than(3.640.51)h,(269.425.4)mL,(121.417.8)mL,and(14.33.1)d in the control group(P0.05).At 7 days,3 months after operation and at the last follow-up,the JOA scores of thetwo groups increased significantly and ODI scores of the two groups decreased signifi
21、cantly;the JOA scores of the studygroup were(15.640.87)points,(22.731.51)points,and(24.383.05)points,which were significantly higher than(13.010.52)points,(18.221.03)points,and(22.042.61)points of the control group(P0.05);the postoperative ODIscores of the study group were(19.43.5)%,(11.32.4)%,and(8
22、.31.6)%,which were significantly lower than(25.73.7)%,(17.92.8)%,and(14.72.1)%of the control group(P0.05);at the last follow-up after treatment,thespinal nerve function of the patients in the study group was significantly better than that of the control group(P0.05).The total incidence of postoperat
23、ive complications was 5.0%in the study group and 2.5%in the control group,with no statistically significant difference(P0.05).ConclusionUnilateral pedicle screw rod internal fixation com-bined with autogenous iliac bone transplantation through Wiltse approach has a significant effect in the treatmen
24、t of sin-gle segment lumbar spondylolysis,which can effectively reduce the amount of intraoperative bleeding,postoperativedrainage,postoperative pain,and improve the lumbar sports function of patients,with a significant clinical effect andhigh safety.It is worthy of promotion and application.【Key wo
25、rds】Single segment lumbar spondylolysis;Wiltse approach;Unilateral pedicle screw rod internal fixa-tion;Autogenous iliac bone transplantation;Efficacy;Safety表1两组患者的一般资料比较x-s,例(%)Table 1Comparison of general data of two groups x-s,n(%)组别研究组对照组2/t值P值例数4040男/女32(80.00)/8(20.00)31(77.50)/9(22.50)0.0750.
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