髓核摘除单侧Cosmic动态固定治疗腰椎间盘突出症

目的比较单侧Cosmic动态固定或单侧椎弓根钉内固定治疗腰椎间盘突出症的临床疗效。方法将自2010-01—2012-09诊治的36例腰椎间盘突出症（L5S1）患者随机分为髓核摘除单侧Cosmic固定组18例（非融合组）和椎间融合单侧椎弓根钉内固定组18例（融合组）。结果 2组获得平均随访21个月（12-26个月）。2组患者症状改善明显,术后VAS及ODI评分与术前比较差异有统计学意义（P0.05）,融合组手术节段及腰椎ROM较术前明显减小,邻近节段ROM与术前相比差异无统计学意义（P〉0.05）。结论采用单侧Cosmic动态固定治疗腰椎间盘突出症可以取得满意的疗效,且手术时间短、出血量少,并能保留固定节段及腰椎的活动度。

Application of unilateral Cosmic dynamic stabilization in treatment of lumbar disc herniation

Objective To determine the effectiveness of unilateral Cosmic dynamic stabilization in treatment of lumbar disc herniation in comparison with the unilateral pedicle screw fixation. Methods From January 2010 to September 2012, 36 patients with lumbar disc herniation （L5S1） were randomized into a non-fusion group of discectomy and unilateral dynamic stabilization with the Cosmic system（n =18） and a fusion group of interbody fusion and unilateral pedicle screw fixation（n =18）. Results All cases were followed up for average 21 months, ranging from 12 to 26 months. The general condition of two groups was improved, and their VAS scores and ODI were significantly reduced postoperatively during the whole period of follow-up （P 〈0.01 ）. There were significant differences in duration of operating time and blood loss （P 〈0.01）. In non-fusion group, there was no significant difference in the ROM of the operative segment, adjacent segment and lumbar spine before and after operation （P 〉0.05）. In fusion group, the ROM of the lumbar spine and the operative segment was significantly reduced postoperatively except the ROM of the adjacent segment. Compared with the fusion group, the dynamic stabilization could preserve the motion in an operative segment （P 〉0.05）. Conclusion As a motion-preserving technology, unilateral Cosmic dynamic stabilization is an effective alternative to fusion in the treatment of lumbar disc herniation and has a potential advantage to reduce the operating time and blood loss.