单侧椎弓根钉固定结合椎间融合治疗腰椎间盘突出症

背景：脊柱双侧内固定广泛应用于治疗腰椎退行性疾病,但长期随访发现坚强内固定形成的应力遮挡效应会导致融合椎体的骨量丢失以及临近椎体退变加速。目的：观察单侧椎弓根螺钉内固定椎间融合治疗腰椎间盘突出症的临床效果。方法：2006-01/2010-01江苏大学附属武进医院对45例一侧肢体为主要症状的腰椎间盘突出症患者进行经椎间孔后路椎间融合单侧椎弓根螺钉内固定。结果与结论：45例患者均获得随访,随访时间6～24个月。全部切口均一期愈合,未发生切口感染。JOA评分和目测类比疼痛评分两项指标均有显著改善,固定后及末次随访与固前相比,差异有显著性意义（P〈0.01）。45例患者中优36例,良5例,可4例,优良率为91%。6个月后X射线及CT提示椎间融合,椎间融合器无移位,无沉降,内固定无松动、断裂。提示单侧神经减压椎间融合和单侧椎弓根螺钉固定是可行的脊柱外科技术,治疗腰椎间盘突出症可获得满意的临床效果。

Interbody fusion with pedicle screw fixation for the treatment of lumbar disc herniation

BACKGROUND：Spine bilateral fixation is widely used in the treatment of lumbar degenerative disease,but the long-term follow-up found that the rigid internal fixation-formed stress shielding effect can cause the bone loss of fusion vertebral and accelerate the degeneration of adjacent vertebral bodies.OBJECTIVE：To explore the efficiency of unilateral vertebral plate interbody fusion with pedicle screw fixation in treatment of lumbar disc herniation.METHODS：From January 2006 to January 2010,45 patients with lumbar disc herniation were treated with unilateral transforaminal lumbar interbody fusion and unilateral internal fixation in Affiliated Wujin Hospital to Jiangsu University.RESULTS AND CONCLUSION：All the 45 patients were followed up.The mean follow-up period for 45 patients was 6-24 months.None of the patients got incision infection.The JOA score and visual analogue score were improved obviously after fixation;the difference was significant（P 0.01） compared with pre-fixation.Among the 45 patients,36 cases were excellent,5 cases were good,4 cases were mean,and the good rate was 91%.The X-ray film and the CT image at 6 months after fixation showed the interbody fusion without displacement and settlement,as well as the fixation with no loosening and fracture.Unilateral neural decompression interbody fusion and unilateral pedicle screw fixation are feasible spinal surgery techniques and are satisfactory in treating patients with lumbar disc herniation.