改良单侧PLIF治疗腰椎间盘突出症伴腰椎不稳的疗效观察

目的比较改良单侧后路腰椎椎体间融合术(PLIF)与传统PLIF治疗腰椎间盘突出症伴腰椎不稳症的临床疗效。方法回顾性分析自2014-07—2015-06诊治的60例单节段腰椎间盘突出症伴腰椎不稳,采用改良单侧PLIF治疗30例(观察组),采用传统PLIF治疗30例(对照组)。比较2组手术时间、术中出血量、植骨融合率,术后4周及末次随访时的VAS评分、ODI指数,末次随访时的JOA评分及优良率,以及并发症情况。结果观察组手术时间、术中出血量少于对照组,差异有统计学意义(P0.05)。观察组28例获得随访,随访时间(16.81±4.27)个月;对照组26例获得随访,随访时间(15.59±4.49)个月。2组植骨融合率差异无统计学意义(P0.05)。观察组术后4周及末次随访时的VAS评分、ODI指数均低于对照组,末次随访时JOA评分优良率高于对照组,差异有统计学意义(P0.05)。结论改良单侧PLIF治疗腰椎间盘突出症伴腰椎不稳的创伤相对较小,有利于患者后期的功能恢复;同时术中能够有效减少对椎管内的干扰,减少术中出血量,有效缩短手术时间,疗效满意。

Clinical efficacy of unilateral posterior lumbar interbody fusion and pedicle screw fixation for lumbar disc herniation with lumbar instability

Objective To observe the clinical efficacy of the modified unilateral posterior lumbar interbody fusion(PLIF) with traditional PLIF for treatment of lumbar dis herniation with lumbar instability.Methods The clinical data of 60 single segmental lumbar disc herniation patients with lumbar instability in our hospital treated from July 2014 to June 2015 were analyzed retrospectively.Thirty patients underwent unilateral pedicle screw fixation and intervertebral cage fusion(observation group) while 30 patients received traditional posterior lumbar interbody fusion (control group).The surgical blood loss,surgical time,bony fusion rate,VAS score and Oswetry disability index 4 weeks postoperatively and at last follow up,the JOA score,excellent rate and complication at last follow up of two groups were observed.Results The surgical blood loss and surgical time of observation group was significantly lower than that in control group (P ＜0.05).Twenty-eight cases were followed up in observation group,the follow up time was (16.81 ±4.27)months.Twenty-six cases were followed up in control group,the follow up time was (15.59±4.49)months.There was no significant difference in the bony fusion rate between the two groups (P ＞0.05).The VAS score and Oswetry disability index 4 weeks postoperatively and at last follow up in observation group were significantly lower than those in control group,the JOA score,excellent rate and complication at last follow up in observation group were significantly higher than those in control group (P ＜0.05).Conclusion Compared with the traditional PLIF,the modified unilateral PLIF surgical method has less trauma,it is helpful for the recovery of lumbar function and at the same time it can reduce the interference within the lumbar spinal canal during operation,reduce the amount of bleeding during surgery,and shorten the operation time.The curative effect is satisfactory.