单侧椎弓根固定椎体间融合加后外侧融合治疗复发性腰椎间盘突出短期疗效观察

目的：探讨单侧经椎弓根螺钉固定椎体间融合和后外侧融合治疗复发性腰椎间盘突出的有效性。方法：将26例复发性腰椎间盘突出患者随机均分为单侧固定组及双侧固定组；在椎体间融合和后外侧融合的基础上，单侧组仅行手术节段单侧椎弓根固定、双侧组行手术节段双侧固定。对比分析两组患者的手术时间、出血量、住院时间、医疗费用，以及术前和术后1个月视觉模拟（VAS）评分及Os-westry Disability Index（ODI）评分。结果：单侧固定组手术时间、出血量、住院时间和医疗费用均低于双侧固定组（P〈0．05）。两组手术后VAS评分及ODI评分均较术前有明显改善（P〈0．05），两组之间术前或术后VAS评分及ODI评分比较，差异无统计学意义（P〉0．05）。结论：单侧椎弓螺钉固定椎体间融合和后外侧融合治疗复发性腰椎间盘突出的临床疗效与双侧固定临床疗效相似，但是单侧固定减少了手术时间、出血量、住院时间及医疗费用，减少了内植物置入时的风险。

The Recurrent Lumbar Disc Herniation Treated by a Unilateral Pedicle Screw Fixation with Lumbar Interbody Fusion and Posterolateral Lumbar Fusion

Objective：To determine the effectiveness of a unilateral pediele screw fixation with lumbar interbody fusion and posterolateral lumbar fusion in the treatment of recurrent lumbar disc herniation. Methods ：Twenty-six patients with recurrent lumbar disc herniation were divided randomly into group A and B, which accepted bilateral and unilateral fixation, respectively. All the patients underwent lumbar interbody fusion and posterolateral lumbar fusion. The operative time, blood loss, hospital stay, medical expenses, pre- andpostoperative scores measured by Visual Analog Scale （VAS） and Oswestry Disability Index （ODI） , were analyzed and compared between the two groups. Results：There was not significant difference between the two groups in the pre- and postoperative scores bf VAS and ODI（ P 〉 0.05 ）, but had obvious difference in blood loss, operating time, hospital stay, and medical expenses（P 〈 0.05 ）. The postoperative scores of VAS and ODI were higher than the preoperative in both groups （ P 〈 0. 05 ）. Conclusions： The effect of unilateral pedicle screw fixation with lumbar interbody fusion and posterolateral lumbar fusion in the treatment of recurrent lumbar disc herniation is equal to that of bilateral fixation. However, the method with unilateral fixation could decreases the operating time, blood loss, hospital stay and medical cost, and reduces possible risk of inserting screws.