The comparative study of three different fixation methods via muscle-splitting approach to treat single segmental lumbar vertebral diseases
10.3760/cma.j.issn.0253-2352.2017.08.005
- VernacularTitle:单节段腰椎病变通道下肌间隙入路三种固定方式的对比研究
- Author:
Zhongyou ZENG
;
Jianqiao ZHANG
;
Weifeng YAN
;
Yongxin SONG
;
Jianfei JI
;
Jianfu HAN
;
Hui JIN
;
Fei PEI
- Keywords:
Lumbar vertebrae;
Internal fixators;
Spinal fusion;
Treatment outcome;
Comparative study
- From:
Chinese Journal of Orthopaedics
2017;37(8):480-491
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the advantages and disadvantages of three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases.Methods All of 90 patients with the single segmental lumbar vertebral diseases were treated from June 2012 to June 2013,including 34 males and 56 females,at the age of 27-76 years old,averagely (53.37± 15.41) years.Twenty-seven patients were treated with unilateral pedicle screws via unilateral muscle-splitting approach (unilateral fixation group).Thirty-three patients were treated with unilateral pedicle screws and contralateral translaminar facet screw via unilateral muscle-splitting approach (combined fixation group).Thirty patients were treated with unilateral pedicle screws via bilateral muscle-splitting approach (bilateral fixation group).Observe and compare the imaging and clinical results of these three groups.Results There were no significant difference in incision length and postoperative wound drainage between these three groups.The operation time was shortest in unilateral fixation group,while longest in bilateral fixation group.In the intraoperative blood loss,the unilateral fixation group was the same as the combined fixation group,while less than the bilateral fixation group.No infection was found after operations.Seven patients experienced epidermal necrosis of the incision,including 1 patient of unilateral fixation group,4 patients of combined fixation group and 2 patients of bilateral fixation group.Three patients suffered from nerve injury,including 2 patients of combined fixation group and 1 patients of bilateral fixation group.The follow-up time was from 12 to 36 months,averagely 25.5 months.The intervertebral height of lesion segments was apparently recovered after surgery,and maintained during the follow-up in these three groups.No significant changes of area and grade of multifidus muscle were detected at 1 year after surgery compared with preoperative.Seven patients experienced endplate cutting and cage partially embedded into vertebral body,including 3 patients of unilateral fixation group,3 patients of combined fixation group and 1 patient of bilateral fixation group.There was no loosening,displacement,breakage or cage shifting.Except 5 patients (2 patients of unilateral fixation group,2 patients of combined fixation group and 1 patient of bilateral fixation group),the remaining cases had well interbody fusion.At the final follow-up time,the JOA score significantly increased compared with preoperative.Besides,unilateral fixation group and combined fixation group were superior to bilateral fixation group.Conclusion Three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases had well clinical results.The unilateral fixation and combined fixation via muscle-splitting approach had more advantages.The combined fixation via muscle-splitting approach is an innovation in approach,exposure and fixation aspects.
