单、双侧后外侧椎弓根钉植入结合植骨融合治疗退变性腰椎滑脱的疗效探讨

目的对比研究单、双侧后外侧椎弓根钉植入结合植骨融合治疗退变性腰椎滑脱的疗效。方法选取该院2010年6月—2014年2月收治的退行性腰椎滑脱症患者80例。按照手术方式的不同将其分实验组和对照组,实验组患者40例,采用单侧后外侧椎弓根钉植入结合植骨融合术,对照组患者40例,采用双侧后外侧椎弓根钉植入结合植骨融合术,术后比较两组患者的临床疗效。结果在该研究中,两组患者在手术疗效、术中出血量以及住院时间差异无统计学意义,实验组手术时间明显少于对照组。临床优良率采用Nakai评分标准：实验组患者共有优24例,良14例,中2例,差0例,优良率达到95.0%;对照组患者共有优24例,良12例,中4例,差0例,优良率达到90.0%。经比较两组优良率差异无统计学意义（P〉0.05）。结论在该实验中,从手术临床疗效上看,两组患者差异无统计学意义,但单侧内固定具有成本低和手术时间少的优点,因此单侧内固定后外侧椎弓根钉植入结合植骨融合治疗退变性腰椎滑脱更应该在临床中得到推广。

Observation of the Comparison of Efficacy Between Unilateral and Bilateral Posterior Pedicle Screw Implant Combined with Bone Graft and Fusion in the Treatment of Lumbar Degenerative Spondylolisthesis

Objective To compare the efficacy between unilateral and bilateral posterior pedicle screw implant combined with bone graft and fusion in the treatment of lumbar degenerative spondylolisthesis. Methods 80 cases with lumbar degenerative spondylolisthesis admitted in our hospital from June 2010 to February 2014 were selected and divided into the experimental group and the control group according to different ways of operation. The experimental group（40 cases） were treated with unilateral posterior pedicle screw implant combined with bone graft and fusion, while the control group（40 cases） were treated with bilateral posterior pedicle screw implant combined with bone graft and fusion. The clinical efficacies of the two groups were compared. Results In this study, there was no significant difference in the surgical effect, intraoperative blood loss, and the length of stay between the two groups; the duration of operation of the experimental group was significantly less than that of the control group. The clinical excellent and good rate was evaluated by Nakai score： in the experimental group, the treatment effect was excellent in 24 cases,good in 14 cases, fair in 2 cases, and no poor case, the excellent and good rate reached 95.0%; in the control group, the treatment effect was excellent in 24 cases, good in 12 cases, fair in 4 cases, and no poor case, the excellent and good rate reached 90.0%.The difference in excellent and good rate between the two groups was not statistically significant（P〉0.05）. Conclusion This study shows that although the difference in clinical effect of surgery between the two groups is not significant, the unilateral internal fixation has the advantages of lower cost and less operation time, so unilateral posterior pedicle screw implant combined with bone graft and fusion for lumbar degenerative spondylolisthesis should be promoted priorly in clinical practice.