[1]朱凌,谷艳超,严浩,等.导板引导椎板关节突螺钉结合腰椎单边椎弓根钉棒系统的临床应用[J].中国中医骨伤科杂志,2022,30(12):61-65.
　ZHU Ling,GU Yanchao,YAN Hao,et al.Clinical Application of 3D Printed Guide Plate to Guide Lamina Articular Process Screw Placement Combined with Unilateral Pedicle Screw Placement[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2022,30(12):61-65.
点击复制

导板引导椎板关节突螺钉结合腰椎单边椎弓根钉棒系统的临床应用()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第30卷
期数:
2022年12期
页码:
61-65
栏目:
临床报道
出版日期:
2022-12-15

文章信息/Info

Title:
Clinical Application of 3D Printed Guide Plate to Guide Lamina Articular Process Screw Placement Combined with Unilateral Pedicle Screw Placement
文章编号:
1005-0205(2022)12-0061-05
作者:
朱凌1; 谷艳超1; 严浩1; 王小阵1; 郑胜东1; 吴浙栋1; 鲁齐林2△
1湖北六七二中西医结合骨科医院骨科(武汉,430079) 2武汉体育学院运动医学院
Author(s):
ZHU Ling1; GU Yanchao1; YAN Hao1; WANG Xiaozhen1; ZHENG Shengdong1; WU Zhedong1; LU Qilin2△
1Hubei 672 Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan 430079,China; 2College of Sports Medicine,Wuhan Sports University,Wuhan 430079,China.
关键词:
3D打印;  椎板关节突螺钉;  导板;  腰椎;  微创
Keywords:
3D printing;  laminar facet screw;  guide plate;  lumbar spine;  minimally invasive
分类号:
R687.3
文献标志码:
B
摘要:
目的:研究3D打印导板引导下椎板关节突螺钉置钉联合单边椎弓根螺钉置钉在腰椎融合术中应用的临床疗效。方法:选取2019年2月至2022年4月因腰椎退行性疾病,运用3D打印导板引导椎板关节突螺钉结合单边椎弓根钉棒系统腰椎融合手术且随访满1年患者,共36名,男19例,女17例,年龄为(48.98±11.84)岁。分别记录术前、术后第7天、第3个月、第12个月的功能障碍指数(ODI)评分、腰腿痛视觉模拟量表(VAS)评分及手术时间、术中出血量、术中透视次数、术后引流量并进行统计学分析。结果:所有患者均顺利完成手术,无术中更换手术方式情况; 36名患者均获得随访,随访时间为(14.71±1.26)个月,无椎间不融合案例。患者术后第7天、第3个月、第12个月ODI评分较术前均明显改善,差异有统计学意义(P<0.05); 患者术后第7天、第3个月、第12个月腰腿VAS评分较术前均明显改善,差异有统计学意义(P<0.05); 患者手术时间为(107.92±18.73)min。术中透视(4.65±0.91)次,术中出血量为(84.47±16.39)mL,术后引流量为(69.32±13.76)mL。结论:3D打印导板引导椎板关节突螺钉结合单边椎弓根钉棒系统应用于腰椎融合术中疗效满意,手术时间、术中出血量、术中透视次数、术后引流量较少,软组织损伤小,符合微创理念,值得推广应用。
Abstract:
Objective:To study the clinical efficacy of lamina articular facet screw placement combined with unilateral pedicle screw placement guided by a self-made 3D printed guide.Methods:A total of 36 patients who underwent lumbar fusion surgery from February 2019 to April 2022 were selected, including 19 males and 17 females, with aged(48.98±11.84)years old. The Oswestry disability index(ODI)score,visual analogue scale(VAS)score of waist and leg, operation time, intraoperative blood loss, Intraoperative fluoroscopy times and postoperative drainage before operation, 7 d, 3 months and 12 months after operation were recorded respectively and statistically analyzed.Results:All patients successfully completed the operation, and there was no intraoperative change of surgical method; 36 patients were followed up, and the follow-up time was(14.71±1.26)months. There was no non-fusion case. The VAS scores of the waist and legs and VAS scores of the patients 7 d, 3 months and 12 months after the operation were significantly improved compared with those before the operation, which was statistically significant(P<0.05); the operation time of patients was(107.92±18.73)min; the intraoperative fluoroscopy was performed(4.65±0.91)times; the intraoperative blood loss was(84.47±16.39)mL, and postoperative drainage volume was(69.32 ± 13.76)mL.Conclusion:The application of the self-made 3D printed guide plate to guide lamina articular facet screw placement combined with unilateral pedicle screw placement can significantly shorten the operation time, reduce the number of intraoperative bleeding and fluoroscopy and postoperative bleeding, which has small soft tissue injury conforms to the concept of minimally invasive and is worth popularizing.

参考文献/References:

[1] 刘俊,熊熠,罗政,等.椎弓根钉结合Cage治疗腰椎间盘突出症临床疗效观察[J].中国中医骨伤科杂志,2016,24(1):65-67.
[2] BADIKILLAYA V,AKBARI K K.Comparative analysis of unilateral versus bilateral instrumentation in TLIF for lumbar degenerative disorder:single center large series[J].Int J Spine Surg,2021,15(5):929-936.
[3] KAHAER A,ZHOU Z,MAITIROUZI J,et al.Biomechanical investigation of the posterior pedicle screw fixation system at level L4/L5 lumbar segment with traditional and cortical trajectories:a finite element study[J].J Healthc Eng,2022,28:4826507.
[3] FERRARA L A,SECOR J L,JIN B H,et al.A biomechanical comparison of facet screw fixation and pedicle screw fixation:effects of short-term and long-term repetitive cycling[J].Spine(Phila Pa 1976),2003,28(12):1226-1234.
[4] MAGERL F P.Stabilization of the lower thoracic and lumbar spine with external skeletal fixation[J]. Clin Orthop Relat Res,1984,189:125-141.
[5] GAWA D,KAYANJA M M,REINHARDT M K,et al.Bone-mountd miniature robotic guidance for pediele screw and translaminar facet screw placement:part 2-evaluation of system accuracy[J].Neurosurgery,2007,60(2 suppl 1):129-139.
[6] KIM T H,LEE B H,MOON S H,et al.Comparison of adjacent segment degeneration after successful posterolateral fusion with unilateral or bilateral pedicle screw instrumentation:a minimum 10-years follow-up[J].Spine J,2013,13(10):1208-1216.
[7] CAO Y,CHEN Z,JIANG C,et al.The combined use of unilateral pedicle screw and contralateral facet joint screw fixation in transforaminal lumbar interbody fusion[J].Eur Spine J,2015,24(11):2607-2613.
[8] LI X H,SHE L J,ZHANG W,et al.Biomechanics of extreme lateral interbody fusion with different internal fixation methods:a finite element analysis[J].BMC Musculoskelet Disord,2022,23(1):134.
[9] BURTON D,MCIFF T,FOX T,et al.Biomechanical analysis of posterior fixation techniques in a 360° arthrodesis model[J].Spine(Phila Pa 1976),2005,30(24):2765-2771.
[10] DEGUCHI M,CHENG B C,SATO K,et al.Biomechanical evaluation of translaminar facet joint fixation.A comparative study of poly-L-lactide pins,screws,and pedicle fixation[J].Spine(Phila Pa 1976),1998,23(12):1307-1312.
[11] SCHLEICHER P,BETH P,OTTENBACHER A,et al.Biomechanical evaluation of different asymmetrical posterior stabilization methods for minimally invasive transforaminal lumbar interbody fusion[J].J Neurosurg Spine,2008,9(4):363-371.
[12] GONG Z,CHEN Z,FENG Z,et al.Finite element analysis of 3 posterior fixation techniques in the lumbar spine[J].Orthopedics,2014,37(5):441-448.
[13] KMÜRCÜ E,KAYMAZ B,ADAM G,et al.Safety and feasibility of lumbar spine for intralaminar screw fixation:a computed tomography-based morphometric study[J].Acta Orthop Traumatol Turc,2015,49(5):522-529.
[14] HU Y,ZHU B K,KEPLER C K,et al.A comparison study of three posterior fixation strategies in transforaminal lumbar interbody fusion lumbar for the treatment of degenerative diseases[J].Indian J Orthop,2019,53(4):542-547.
[15] 陈毅,赵亮,王利民.3D打印辅助四级截骨术治疗创伤性脊柱后凸畸形30例[J].中国中医骨伤科杂志,2021,29(2):41-44.

备注/Memo

备注/Memo:
△通信作者 E-mail:gkluql@163.com
更新日期/Last Update: 2022-12-10