单双侧椎弓根螺钉椎体问融合术治疗腰椎退行性疾病的疗效比较

目的 比较单、双侧椎弓根螺钉椎体间融合术治疗腰椎退行性疾病的临床疗效.方法 2006年10月至2010年10月采用后路椎体间融合椎弓根螺钉固定治疗资料完整的60例腰椎退行性疾病患者,根据固定方式分为A、B两组.A组应用单侧椎弓根螺钉椎体间融合术治疗28例,男16例,女12例;年龄40～56岁,平均48岁.术前诊断:腰椎椎间盘脱出4例,腰椎椎间盘术后复发6例,腰椎管狭窄症6例,腰椎退行性不稳8例,退行性腰椎滑脱症4例.B组应用双侧椎弓根螺钉椎体间融合术治疗32例,男18例,女14例;年龄42～67岁,平均52岁.术前诊断:腰椎椎间盘脱出5例,腰椎椎间盘术后复发6例,腰椎管狭窄症7例,腰椎退行性不稳6例,退行性腰椎滑脱症8例.使用ODI评分、VSA视觉模拟评分对两组患者术前评分及术后评分,并比较两组的手术时间、失血量、融合率、医疗费用、手术优良率、并发症发生率等情况.结果 两组患者ODI评分、VSA视觉模拟评分术前与术后3个月、6个月比较差异有统计学意义(PO 05),两组融合率分别为92%、94%.结论 单、双侧椎弓根螺钉椎体间融合术治疗腰椎退行性疾病临床疗效均满意,单侧椎弓根螺钉椎体间融合术创伤小,经济简便,是治疗腰椎退行性疾病的较好选择;但应严格掌握手术适应证,长期疗效尚需进一步临床研究.

Unilateral versus bilateral pedicle screw fixation with lumbar interbody fusion in treating lumbar degenerative disease

Objective To compare clinicaleffects of lumbar interbody fusion with unilateral pedicle screwfixation and bilateral pedicle screw fixation in treating lumbar degenerative disease . Methods Form October 2006 toOctober 2010,sixty cases were treated with lumbar interbody fusion with unilateral pedicle screw fixation or bilateralpedicle screw fixation ,and were divided into two groups according to internal fixation mode. There were 28 cases ofwhich underwent lumbar interbody fusion with unilateral diagnosis consisted of lumbar disc herniation （n=4）,postoperative recurrent lumbar disc herniation （n=6）,spinal stenosis（n=6）,degenerative lumbar instability （n=8）,degenerative spondylolisthesis （n = 4 ）. There were 32 cases of which underwent lumbar interbody fusion withbilateral pedicle screw fixation, 18 males and 14 femMes with an average of 52 years （range ,42-67 ）. The preoperative diagnosis consisted of lumbar disc herniation （ n = 5 ）, postoperative recurrent lumbar disc herniation （ n = 6 ）, spinal stenosis （ n = 7 ） , degenerative lumbar instability （ n = 6 ） , degenerative spondylolisthesis （ n = 8 ）. Pre- and post-operative scores measured by Oswestry Disability Index （ODI） and Visual Analog Scale （VAS） were analyzed and compared between tile two groups. Comparison was conducted between two groups in terms of operation duration , intraoperative blood loss, fusion rates, operative cost, excellence rate,incidence rate of complications. Results ODIand VAS in two groups showed statistical significance between preoperation and 3 months ,6 months postopev＇ation （ P 〈 0. 05 ）. Compared with B group, A group had shorter operation duration, less intraoperative blood loss and lower operative cost, with statisticM difference （ P 〈 0. 05 ）. No significant difference was found between two groups in thefusion rates ,excellence rate, incidence rate of complications （ P 〉 0. 05 ）. The fiasion rate of two groups were 92%, 94% respectively. Conclusions Lumbar interbody fusion with unilateral pedicle screw fixation is as effective as with bilateral pedicle screw fixation. It is demomstrated that lumbar interbody fusion with unilateral pedicle screw fixation was an effective and convenient method with little surgical trauma as well as a satisfying method in treating lumbar degenerative disease. But the operation indications must be. strictly defined and long-term clinical studies are required.