单侧椎弓根螺钉联合PLIF治疗腰椎间盘突出伴腰椎不稳症疗效观察

目的 探讨单侧椎弓根螺钉内固定联合腰椎后路椎间融合术(PLIF)治疗腰椎间盘突出伴腰椎不稳定患者的临床效果.方法 选取2014年1月至2015年6月我院拟实施手术治疗的腰椎间盘突出伴腰椎不稳定患者76例,采用随机数表法分为单侧组(单侧椎弓根螺钉内固定+PLIF)和双侧组(双侧椎弓根螺钉内固定+PLIF),每组38例,比较两组患者术后腰椎功能恢复、疼痛程度等指标的差异.结果 单侧组患者的手术时间和手术出血量分别为(95.8±11.7)min、(304.8±55.7)mL,均低于双侧组患者的(110.4±17.0)min、(482.6±84.5)mL,差异均有统计学意义(P<0.05);术后1周、1个月、3个月,单侧组患者的ODI指数分别为(22.04±6.95)%、(12.87±4.03)%、(13.16±4.76)%,均低于双侧组的(25.59±7.80)%、(16.48±5.52)%、(16.42±5.17)%,差异均有统计学意义(P<0.05);单侧组患者术后骨性融合平均时间为(7.9±1.7)个月,与双侧组的(8.2±1.9)个月比较差异无统计学意义(P>0.05);术后1年,单侧组患者完全骨性融合率为100.00%,双侧组97.37%,两组比较差异无统计学意义(P>0.05).结论 单侧椎弓根螺钉内固定联合PLIF治疗腰椎间盘突出伴腰椎不稳定患者具有手术创伤小、术后恢复快、治疗效果更好的优点.

Clinical effects of unilateral pedicle screw combined with posterior lumbar interbody fusion in the treatment of lumbar disc herniation with lumbar instability

Objective To investigate the clinical effects of unilateral pedicle screw fixation and posterior lum-bar interbody fusion (PLIF) in the treatment of lumbar disc herniation with lumbar instability. Methods From January 2014 to June 2015, 76 patients with lumbar disc herniation and lumbar instability were treated with surgical treatment in our hospital, who were divided into the unilateral group (unilateral pedicle screw fixation+PLIF) and the bilateral group (bilateral pedicle screw fixation + PLIF) according to the stochastic indicator method, with 38 cases in each group. The differences of the recovery of lumbar function and the degree of pain between the two groups were com-pared. Results The operation time and surgical blood loss of the unilateral group of patients were respectively (95.8 ± 11.7) min and (304.8±55.7) mL, which were significantly lower than (110.4±17.0) min and (482.6±84.5) mL of the bilat-eral group (P<0.05). After 1 week, 1 month, 3 months, the ODI index of the unilateral group were respectively (22.04 ± 6.95)%, (12.87±4.03)%and (13.16±4.76)%, which were significantly lower than corresponding (25.59±7.80)%, (16.48± 5.52)%and (16.42±5.17)%of the bilateral group (P<0.05). The average time of bony fusion of the unilateral group and the bilateral group were respectively (7.9±1.7) months and (8.2±1.9) months, with no significant difference between the two groups (P>0.05). One year after surgery, the complete unilateral bony fusion rate in the unilateral group and the bilat-eral group were respectively 100.00%and 97.37%, and there there was no significant difference between the two groups (P>0.05). Conclusion Unilateral pedicle screw fixation combined with PLIF has the characteristics of less operative trauma, faster postoperative recovery and better treatment effect in the treatment of lumbar disc herniation complicated with lumbar instability.