直视法植入螺钉在腰椎退变性疾病椎弓根螺钉固定的应用

目的　探讨直视法植入螺钉在腰椎退变性疾病椎弓根螺钉固定的应用效果。 方法　120例腰椎退变性疾病行后路切开椎弓根螺钉内固定治疗患者。按螺钉植入方式不同，分为以人字嵴为解剖标志的传统法组（A组，80例）和椎板切除或开窗后直视下以椎弓根内下缘为解剖标志的直视法组（B组，40例）。两组患者性别、年龄、病种、病程等一般资料比较，差异无统计学意义（P>0.05）。比较两组植入螺钉的透视时间、植入螺钉时间、术中出血量、融合率、功能恢复（JOA评定法）和并发症情况。 结果　B组的透视时间、植入螺钉时间和术中出血量小于A组，螺钉位置好于A组，差异有统计学意义（P<0.05）；B组的功能恢复和并发症好于A组，但差异无统计学意义（P>0.05）；两组融合率均100%。 结论　直视法植入椎弓根螺钉方法简单、效果良好，可以作为腰椎退变性疾病某些情况下传统法的一种补充。

Application of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation

Objective　To investigate the application effect of screw placed under direct vision in lumbar degenerative disease treated with pedicle screw fixation.　Methods　120 patients with lumbar degenerative disease were treated with pedicle screw fixation by an open posterior approach. According to the placement method of pedicle screw, they were divided into group A with 80 cases using the traditional method adopting the crista lambdoidalis as anatomical marker for screw placement (group A, 80 cases), and group B with 40 cases using the media-inferior edge of the pedicle as the anatomical landmark for screw placement under direct vision after laminectomy or fenestration as anatomical mark. There was no statistically significant difference in general data between the two groups (P>0.05). The fluoroscopy time, placement time of pedicle screw, intraoperative blood loss, position of screw, fusion rate, functionary recovery (JOA score) and incidence of complications were recorded and compared between the two groups.　Results　The fluoroscopy time, placement time, intraoperative blood loss and the position of screw in group B were less or better than those in group A, and the differences were statistically significant (P<0.05); the functional recovery and complications in group B were better than those in group A, but the differences were not statistically significant (P>0.05); the fusion rate was 100% in both groups.　Conclusions　The method of pedicle screw placed under direct vision is simple and effective, which can be used as a supplement to traditional methods in some cases for degenerative diseases of lumbar spine.