单侧椎弓根螺钉固定结合椎间融合治疗腰椎退行性疾病的疗效观察

目的：探讨单侧椎弓根螺钉固定结合椎体间植骨融合治疗腰椎退行性疾病的临床疗效。方法采用旁正中入路单侧椎弓根螺钉固定结合经椎间孔椎体间融合治疗腰椎退行性疾病患者31例。均为单节段病变，其中L3~46例，L4~517例，L5 S18例。记录手术时间、术中出血量及并发症发生情况。术前、术后3个月及末次随访时对腰部和下肢疼痛采用视觉模拟评分（VAS）与Oswestry功能障碍指数（ODI）进行评定，评价临床疗效。结果31例患者均顺利完成手术，未发生严重手术并发症。平均手术时间110min，术中出血量165ml。术后随访31例患者，平均随访时间22个月，无椎弓根螺钉断裂、松动及Cage移位等内植物失败发生。手术前后及随访期间腰部、下肢VAS和ODI分值的差异有统计学意义（P＜0.05）。结论单侧椎弓根螺钉固定结合椎体间融合手术具有创伤小、出血少、恢复快等优点，在合理选择适应证的情况下，可取得良好的临床疗效。

Unilateral pedicle screw fixation with interbody fusion for the treatment of lumbar degenerative diseases

Objective To explore the clinical efficacy of unilateral pedicle screw fixation with transforaminal lumbar inter-body fusion for the treatment of lumbar degenerative diseases. Methods 31 patients with lumbar degenerative diseases under-went unilateral pedicle screw fixion with transforaminal lumbar interbody fusion by paraspinal approach. There were 20 males and 11 females, ranging in age from 40 to 73 years （mean, 56.5years）, al cases had single segment involved （6 cases in L3-4, 15cases in L4-5, 8 cases in L5S1）. The operation time, blood loss were recorded and analyzed. The Visual analog scale （VAS） score, and Oswestry disability index （ODI） were used to assess clinical outcomes. Results The operation of 31 patients was successful, there were no severe complication. The average operative time was 110 min （range, 85-135min）, the average blood loss was 165ml（range,120-320ml）. The patients were fol owed up 12- 40 months （mean, 22months）. No pedicle screw loosening, breaking, or intervertebral fusion cage pul ing- out were observed. The symptoms were obviously improved in al patients after operation. The VAS score and ODI at 3 months and last fol ow- up showed significant differences when compared with preopera-tive ones （P〈0.05）. Conclusion The surgical procedure of unilateral pedicle screw fixation with interbody fusion had the advan-tage including less invasion, less blood loss, and quickly recovery, and the clinical efficacy was satisfactory under suitable indi-cation.