双侧及单侧椎弓根螺钉置入与椎间植骨融合修复老年退行性腰椎滑脱

背景：近年来椎管减压复位内固定联合植骨融合已在临床上广泛应用，双侧椎弓根螺钉辅助椎体间植骨融合及单侧椎弓根螺钉辅助椎体间植骨融合是治疗老年退行性椎管狭窄及腰椎滑脱的主要方法。目的：对比双侧及单侧椎弓根螺钉辅助椎体间融合器植骨融合治疗老年椎管狭窄合并退行性腰椎滑脱的早期临床疗效。方法：纳入60例老年椎管狭窄合并退行性腰椎滑脱患者，其中男37例，女23例，年龄60-78岁，分两组治疗，两组均行椎管减压，治疗组(n=30)行单侧椎弓根螺钉辅助椎体间融合器植骨融合治疗，对照组(n=30)行双侧椎弓根螺钉辅助椎体间融合器植骨融合治疗。治疗后随访1年，以JOA评分评估两组关节功能恢复情况，同时记录并发症情况。结果与结论：治疗组与对照组JOA评分分别为25.7±1.9，25.8±1.8，组间比较差异无显著性意义。治疗组有3例出现下肢麻木，2例发生硬膜撕裂，并发症发生率为17%；对照组3例出现下肢麻木，3例出现硬膜撕裂，并发症发生率为20%，组间并发症发生率比较差异无显著性意义，两组均未发生与植骨材料相关的不良反应。表明采用双侧或单侧椎弓根螺钉辅助椎体间融合器骨植骨融合治疗老年退行性椎管狭窄合并腰椎滑脱均有较好的疗效。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Bilateral and unilateral pedicle screw assisted interbody fusion for degenerative lumbar spondylolisthesis in the elderly

BACKGROUND:Spinal canal decompression reduction fixation combined with bone graft fusion has been extensively applied in the clinic. Bilateral pedicle screw assisted interbody fusion and unilateral pedicle screw assisted interbody fusion are main methods to treat degenerative lumbar spinal stenosis and lumbar spondylolisthesis. OBJECTIVE:To compare early clinical therapeutic effects of bilateral and unilateral pedicle screw assisted interbody fusion in elderly patients with spinal stenosis and degenerative spondylolisthesis. METHODS:A total of 60 elderly patients with spinal stenosis with degenerative lumbar spondylolisthesis were selected, including 37 males and 23 females, at the age of 60 to 78 years old. They were divided into two groups, and subjected to decompression of spinal canal. In the treatment group (n=30), patients received unilateral pedicle screw assisted interbody fusion. In the control group (n=30), patients received bilateral pedicle screw assisted interbody fusion. After treatment, they were followed up for 1 year. The recovery of joint function was assessed using Japanese Orthopaedic Association scores in both groups. Simultaneously, complications were recorded. RESULTS AND CONCLUSION:Japanese Orthopaedic Association scores were 25.7±1.9 and 25.8±1.8 in the treatment and control groups, respectively, and no significant difference was found between groups. In the treatment group, three cases affected lower limb numbness and two cases suffered from dural tear, with the incidence of complication of 17%. In the control group, three cases affected lower limb numbness and three cases suffered from dural tear, with the incidence of complication of 20%; no significant difference was detected between the two groups. No adverse reaction related to bone graft was found in the two groups. These results confirm that bilateral or unilateral pedicle screw assisted interbody fusion in treatment of degenerative lumbar spondylolisthesis with spinal stenosis obtained good therapeutic effects.