单侧椎弓根螺钉内固定联合椎间融合术治疗退行性腰椎滑脱症的疗效

目的 评价单侧和双侧椎弓根螺钉内固定联合椎体间融合术治疗单节段腰椎退行性滑脱症的临床疗效。方法 采用后入路单侧或双侧椎弓根螺钉内固定联合椎体间融合术治疗52例单节段腰椎退行性滑脱患者。根据内固定方式,将52例患者分为单侧组(25例)和双侧组(27例)。记录并比较两组患者手术前后疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)、手术时间、术中出血量、住院费用及术后腰椎椎间融合率。结果 所有患者均顺利完成手术且获得有效随访。末次随访时VAS、ODI评分同术前相比均明显降低,P<0.01。双侧组患者手术时间、术中出血量和手术费用同单侧组相比均明显增加,P<0.01。两组患者末次随访时,两组患者手术节段均获得牢固融合。结论 后入路腰椎单侧椎弓根螺钉内固定联合椎体间融合术治疗单节段腰椎退行性滑脱可取得与双侧固定相同的临床疗效,且在手术时间、术中出血量、住院费用等方面更具优势。

Effect of lumbar interbody fusion combined with unilateral pedicle screw fixationfor treatment of degenerative lumbar spondylolisthesis

Objective To evaluate the effect of posterior lumbar interbody fusion combined with unilateral and bilateral pedicle screw fixation in treatment of single-level lumbar degenerative spondylolisthesis.Methods Fifty-two patients with single-level lumbar degenerative spondylolisthesis were treated with posterior lumbar interbody fusion combined with unilateral or bilateral pedicle screw fixation.According to the different fixation,they were divided into the unilateral group (25 cases) and the bilateral group (27 cases).The preoperative and postoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores,operation time,intraoperative blood loss,hospitalization costs and fusion rate were recorded and compared between the two groups.Results All patients completed the operation successfully and were followed up.At the last follow-up,VAS and ODI scores were significantly lower than those before surgery,P<0.01.The operation time,intraoperative blood loss and operation cost of patients in the bilateral group significantly increased,compared with those in the unilateral group,P<0.01.At the last follow-up,solid fusion was achieved in both groups.Conclusion The posterior lumbar interbody fusion combined with unilateral pedicle screw and bilateral pedicle screw fixation in treatment of single-level lumbar degenerative spondylolisthesis have comparable clinical outcomes,and unilateral pedicle screw has more advantages on operation time,intraoperative blood loss and hospitalization costs.