組配型橫突拉鉤的研制與臨床應用

·臨床研究·

組配型橫突拉鉤的研制與臨床應用

曾忠友，吳鵬，宋國浩

作者單位：314000浙江，武警浙江省總隊醫院骨二科

【摘要】目的研制組配型橫突拉鉤并探討其臨床應用效果。方法通過腰椎骨骼標本和腰部軟組織的觀察、測量，設計制作了以腰椎橫突為固定支點的組配型拉鉤，將其應用于單側椎弓根螺釘聯合對側經皮椎板關節突螺釘固定并椎間融合植骨的手術方式，并與傳統椎板拉鉤的使用進行比較。對比2組病例手術時間、術中出血量、術后切口引流液量、切口長度、術后72 h腰部切口疼痛視覺模擬量表(visual analogue scale, VAS)評分。采用日本骨科學會(Japanese Orthopaedic Association, JOA) 下腰痛評分法對臨床效果進行評價和對比。結果 在手術時間、術中出血量和切口長度方面，組配型橫突拉鉤組優于椎板拉鉤組，差異有統計學意義(P<0.05)；而在術后切口引流液量、術后72 h腰部切口疼痛VAS評分及最后隨訪JOA評分方面2組相比差異無統計學意義(P>0.05)。結論與傳統椎板拉鉤相比，組配型橫突拉鉤具有容積小、組裝方便、把持性好、固定確切、視野大、對手術操作干擾小以及適合人群和手術方式廣泛等優點，可作為腰椎后路內固定手術的顯露工具。

【關鍵詞】腰椎;外科器械; 椎間盤退行性變; 椎管狹窄; 脊椎滑脫; 脊柱融合術; 內固定器

基金項目：浙江省衛生廳科研項目(2010KYB112)

作者簡介：曾忠友(1969— )， 博士在讀，副主任醫師

【中圖分類號】R 681.533【文獻標志碼】 A

DOI【】

收稿日期：(2013-10-23)

Clinical application and manufacture of matched lumbar transverse process retractor deviceZENGZhong-you,WUPeng,SONGGuo-hao.SecondDeptmentofOrthopaedics,HospitalofZhejiangGeneralCorpsofChinesePeople'sArmedPoliceForces,Jiaxing314000,Zhejiang,China

Abstract【】ObjectiveTo manufacture a matched lumbar transverse process retractor device and investigate its effects in internal fixation of lumbar vertebrae by posterior approach. MethodsBased on the skeletal specimens of the lumbar vertebrae and the lumbar soft tissue thickness, a surgical retractor device was designed. The device took lumbar transverse process as a fixed pivot and was equipped with matched retractors of different functions. It worked to help treatment of lumbar vertebrae diseases by unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation by percutaneou as well as posterior lumbar interbody fusion. Operation time, intraoperative blood loss, postoperative wound drainage, incision length and pain visual analogue scale(VAS) scores at postoperative 72 h were compared between conventional lamina retractor device (conventional retractor group) and the matched lumbar transverse process retractor device (new retractor group). The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the patient's symptoms, physical sign, daily activities and bladder function after treatments in the 2 groups. Results No wound skin necrosis or infection occurred in each group. Compared to conventional retractor group, operation time and incision length was shorter and intraoperative blood loss was less in new retractor group(P<0.05). There were no significant differences in postoperative wound drainage, VAS scores at postoperative 72 h and the JOA scores between the 2 groups(P>0.05). Conclusion The matched lumbar transverse process retractor device has advantages, including smaller volume, easier to assemble and to install, greater holding capacity, more precise fixation position, larger visual field, fewer interventions to operation, more suitable to humans, and available for more surgical methods over conventional lamia retractor device, and therefore is a promising surgical device for internal fixation of lumbar vertebrae by posterior approach.

【Key words】Lumbar vertebrae; Surgical Instruments; Intervertebral disc degeneration； Spinal Stenosis Spondylolysis; Spinal fusion; Internal fixators

J Spinal Surg, 2015,13(1):28-32

腰椎后路內固定術已廣泛應用于臨床，手術的精細化和有限化成為脊柱外科的發展方向，在腰椎后路內固定手術中，如何有效牽開軟組織、顯露脊柱后方結構，在縮短手術切口、減少軟組織的牽拉損害的同時方便手術操作，是脊柱外科醫師努力的方向。……