Wu Ze-Xuan, Xu Hong-Hai, Han Xiao-Fan, Li Wei-Wei, Duan Liang, Duan Da-Peng, Yang Jun-Sheng
Xi'an Medical College, Shaanxi Provincial People's Hospital, Xi'an 710000, Shaanxi, China.
Zhongguo Gu Shang. 2022 Oct 25;35(10):951-6. doi: 10.12200/j.issn.1003-0034.2022.10.008.
To investigate the clinical application of two elastic pedicle internal fixation systems in single-segment lumbar disc herniation fenestration.
A retrospective analysis of 64 patients with lumbar intervertebral disc herniation treated by surgery from June 2019 to March 2021. According to the different elastic fixation systems placed during the operation, the patients were divided into ordinary pedicle screw elastic rod link group (elastic rod group) and a special elastic pedicle screw rigid rod fixed connection group (elastic screw group). There were 33 cases in the elastic rod group, including 18 males and 15 females, aged from 30 to 69 years old with an average of(49.18±10.23) years old;and 31 cases in the elastic screw group, including 16 males and 15 females, aged from 32 to 68 with an average of (49.81±9.24) years old. The operation time, intraoperative blood loss, postoperative wound drainage, and postoperative landing time of the two groups were recorded separately. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were compared before and 3, 12 months after operation. The height of the adjacent vertebral space on the lateral DR film before and 12 months after the operation was measured. The clinical efficacy was evaluated by Macnab standard.
All the patients successfully completed the operation, and were followed up. The operation time, intraoperative blood loss, postoperative wound drainage and postoperative landing time in the elastic rod group were(63.73±12.01) min, (89.55±16.07) ml, (81.67±16.00) ml, (3.45±0.75) d , while in the elastic nail group was (62.96±11.54) min, (88.35±17.14) ml, (82.29±15.40) ml, (3.29±0.78) d, the difference was not statistically significant. The symptoms of low back pain and lower extremity numbness were significantly improved in all patients after operation. There was no significant difference in VAS, JOA score and ODI between the two groups before and after surgery (>0.05). At 12 months after operation, there was no significant difference in the height of the adjacent vertebral space between the upper adjacent vertebral body and the same segment before operation(>0.05), and there was no significant difference between the groups before and after the operation. According to Macnab criteria, the elastic rod group was excellent in 30 cases, good in 2 cases, fair in 1 case, while the elastic nail group was excellent in 29 cases, good in 2 cases, fair in 0 cases, and there was no significant difference(=-0.42, =0.68).
In fenestrated nucleus pulposus extraction for lumbar disc herniation, the two elastic pedicle internal fixation systems are equally effective and can be used. The elastic screw internal fixation system has certain advantages when the distance between the two vertebral bodies is short, and the elastic rod cannot be placed or is difficult to be placed, and it is more widely used.
探讨两种弹性椎弓根内固定系统在单节段腰椎间盘突出症开窗髓核摘除术中的临床应用。
回顾性分析2019年6月至2021年3月行手术治疗的64例腰椎间盘突出症患者。根据手术中所放置的弹性固定系统不同，将患者分为普通椎弓根螺钉弹性棒连接组（弹性棒组）和特殊弹性椎弓根螺钉刚性棒固定连接组（弹性螺钉组）。弹性棒组33例，男18例，女15例，年龄30～69岁，平均（49.18±10.23）岁；弹性螺钉组31例，男16例，女15例，年龄32～68岁，平均（49.81±9.24）岁。分别记录两组患者的手术时间、术中出血量、术后伤口引流量及术后下地时间。比较手术前及术后3、12个月的视觉模拟评分（VAS）、日本骨科学会（JOA）评分及Oswestry功能障碍指数（ODI）。测量术前及术后12个月腰椎正侧位DR片上相邻椎间隙的高度。采用Macnab标准评价临床疗效。
所有患者均顺利完成手术并获随访。弹性棒组手术时间、术中出血量、术后伤口引流量及术后下地时间分别为（63.73±12.01）min、（89.55±16.07）ml、（81.67±16.00）ml、（3.45±0.75）d，弹性螺钉组分别为（62.96±11.54）min、（88.35±17.14）ml、（82.29±15.40）ml、（3.29±0.78）d，差异无统计学意义。所有患者术后腰腿痛及下肢麻木症状均明显改善。两组手术前后VAS、JOA评分及ODI比较，差异均无统计学意义（>0.05）。术后12个月，上相邻椎体与同节段术前相比相邻椎间隙高度差异无统计学意义（>0.05），且组间比较差异无统计学意义。按Macnab标准，弹性棒组优30例，良2例，可1例；弹性螺钉组优29例，良2例，可0例，差异无统计学意义（=-0.42，=0.68）。
在腰椎间盘突出症开窗髓核摘除术中，两种弹性椎弓根内固定系统疗效相当，均可采用。当两椎体间距离较短、弹性棒无法放置或难以放置时，弹性螺钉内固定系统具有一定优势，应用更为广泛。
