Masferrer R, Gomez C H, Karahalios D G, Sonntag V K
Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, USA.
J Neurosurg. 1998 Sep;89(3):371-7. doi: 10.3171/jns.1998.89.3.0371.
The goal of this study was to review retrospectively the outcome of 95 patients with various disorders leading to instability of the thoracolumbar and lumbar spine who were treated consecutively via a posterior surgical approach with pedicle screw fixation in which the Texas Scottish Rite Hospital system was used.
All cases were managed according to the same protocol. Follow-up review averaged 29.6 months. Radiographic evidence of osseous union and the patient's current status were analyzed. Four screws were malpositioned, and there were two dural lacerations of a nerve root and one pedicle fracture. Deep wound infections developed in five patients (5.2%), and three patients had postoperative radicular pain. In one case, the rods disengaged from the screws; in four cases, hardware was removed but there were no broken screws. Neurological deficits improved in 85% of the surviving patients, and no patient was worse neurologically after surgery. The rate of osseous union was 96.8%. Three patients developed pseudarthrosis, one of whom was asymptomatic. Back pain improved in 80 patients. A solid bone fusion, however, was not necessarily associated with decreased back pain.
These results support the use of pedicle screw fixation as an effective and safe procedure for fusion of the thoracolumbar and lumbar spine and support the finding that complications can be minimal when a meticulous surgical technique is used. The proper selection of patients for surgery is probably the most important factor associated with good outcomes.
本研究的目的是回顾性分析95例因各种疾病导致胸腰椎和腰椎不稳的患者的治疗结果，这些患者均通过后路手术采用椎弓根螺钉固定，并使用了德克萨斯州苏格兰礼医院系统。
所有病例均按照相同方案进行处理。随访平均时间为29.6个月。分析了骨愈合的影像学证据和患者的当前状况。有4枚螺钉位置不当，2例出现神经根硬脊膜撕裂，1例发生椎弓根骨折。5例患者（5.2%）发生深部伤口感染，3例患者术后出现神经根性疼痛。1例出现棒与螺钉分离；4例取出了内固定物，但螺钉未断裂。85%存活患者的神经功能缺损有所改善，术后无患者神经功能恶化。骨愈合率为96.8%。3例发生假关节形成，其中1例无症状。80例患者的背痛有所改善。然而，坚实的骨融合并不一定与背痛减轻相关。
这些结果支持将椎弓根螺钉固定作为胸腰椎融合的一种有效且安全的手术方法，并支持这样的发现，即当采用细致的手术技术时并发症可降至最低。正确选择手术患者可能是取得良好疗效的最重要因素。
