单侧腰椎弓根螺钉及经椎板关节突螺钉固定与双侧固定的比较

背景：经椎板关节突关节螺钉固定、椎问植骨融合治疗脊柱疾患是一种独特的固定方法，可用于退变性腰椎的融合。目的：比较采用微创经腰椎间孔椎体融合联合单侧椎弓根螺钉及经椎板关节突螺钉固定与常规开放后路腰椎体间融合术联合双侧椎弓根螺钉固定治疗下腰痛疾病的临床效果。方法：纳入2010年6月至2012年6月于武警广东总队医院就诊的腰椎间盘突出伴腰椎轻度不稳患者49例，均采用后路减压椎间融合器植骨内固定治疗。其中24例采用微创经椎间孔椎体融合术联合单侧椎弓根螺钉及经椎板关节突螺钉固定，25例采用常规开放后路腰椎体间融合术联合双侧椎弓根螺钉固定，比较两种固定方法的临床疗效。结果与结论：两种固定方法术后椎体融合率、日本矫形外科协会评分及疼痛目测类比评分改善率差异均无显著性意义（P〉0．05）。可见对无严重不稳的单节段退变性腰椎疾病患者，两种治疗方法的效果相当，均能有效提高椎间融合率，使小关节稳定，解除临床症状，门诊随访满意。但采用微创经椎间孔椎体融合术联合单侧椎弓根螺钉及经椎板关节突螺钉固定的患者手术切口长度、手术时间、术中出血量、术后切口引流液量明显减少（P〈0．05），说明该方法具有创伤小、操作简单的优势。

Clinical outcomes of unilateral lumbar pedicle screw combined with translamina facet screw fixation versus bilateral fixation

BACKGROUND： The translaminar facet joint screw fixation and interbody fusion in the treatment of spinal disorders is a unique fixation method which can be used for degenerative lumbar spinal fusion. OBJECTIVE： To observe the clinical effect of the minimally invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation versus conventional posterior lumbar interbody fusion combined with bilateral pedicle screw fixation for the treatment of low back pain. METHODS： Forty-nine patients had lumbar disc herniation with lumbar spinal mild instability were selected from Wu Jing Zong Dui Hospital of Guangdong Province between June 2010 and June 2012. All the patients were treated with posterior decompression and interbody fusion and internal fixation. Among the 49 patients, 24 patients were treated with minimally invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation, and 25 patients were treated with conventional posterior lumbar interbody fusion combined with bilateral pedicle screws fixation. The clinical effects of the two methods above were compared. RESULTS AND CONCLUSION： There were no significant differences of vertebral fusion rate, Japanese Orthopedic Association score and visual analogue scale score between two groups （P 〉 0.05）. These two approaches had similar clinical outcomes for single-level lumbar degenerative disorders with no instability. These two methods could effectively improve intervertebral fusion rate, make the small joint stability, relieve clinical symptoms and make outpatient follow-up satisfaction. In addition the incision length, operative time, intraoperative blood loss, postoperative incision drainage of minimally invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation technology were significantly reduced （P 〈 0.05）, and it indicated that the method had the advantages of small trauma and simple operation.