单枚cage和单枚cage加单侧椎弓根螺钉内固定术治疗腰椎间盘突出并腰椎不稳症  

Single-cage and single cage plus unilateral pedicle screw fixation for lumbar disc herniation complicated with lumbar instability

作　　者：张建华[1] 李新志[1] 周宏斌 王光勇 李菲霰[1] 陈文瑶[1] 王宪伟[1] 余洋[1] 

机构地区：[1]三峡大学仁和医院骨科,湖北省宜昌市443001 [2]湖北省宜昌市夷陵区医院骨科,443001

出　　处：《中国脊柱脊髓杂志》2010年第6期457-461,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:观察减压后采用单枚椎间融合器(cage)植骨融合术和单枚cage植骨融合加单侧椎弓根螺钉内固定术治疗腰椎间盘突出合并腰椎不稳症的疗效。方法:2006年1月～2008年1月我科收治62例单节段腰椎间盘突出合并腰椎不稳症患者。其中28例减压后采用单枚cage植骨融合术治疗(A组),34例减压后采用单枚cage植骨融合加单侧椎弓根螺钉内固定术治疗(B组)。手术前后按日本矫形外科学会(JOA)腰痛评分15分法(包括主观症状、客观体征、膀胱功能)评定神经功能,计算改善率和优良率。随访观察植骨融合情况和与cage相关的并发症发生情况。结果:术前JOA评分两组比较无显著性差异(P>0.05),随访12～30个月,平均24个月,末次随访时JOA评分两组比较有显著性差异(P<0.05),同组末次随访时JOA评分与术前比较有显著性差异(P<0.01)。A组改善率平均为78.12%,B组为94.32%;A组优良率为82.14%,B组为97.06%;A组植骨融合率为78.57%,B组为97.06%。两组间改善率、优良率、植骨融合率均有显著性差异(P<0.05)。A组与cage相关并发症(cage脱出、移位和沉降各2例)的发生率为21.43%(6/28),B组cage移位1例(1/34,2.94%),两组比较有显著性差异(P<0.05)。结论:减压后采用单枚cage植骨融合术和单枚cage植骨融合加单侧椎弓根螺钉内固定术都能有效治疗腰椎间盘突出合并腰椎不稳症,但后者植骨融合率较高,融合器相关并发症较少。Objective:To investigate the surgical outcome of single-cage and single cage plus unilateral pedicle screw fixation after decompression for lumbar disc herniation complicated with lumbar instability.Method:From January 2006 to January 2008,62 cases of lumbar disc herniation complicated with lumbar instability were reviewed retrospectively.28 cases underwent a single cage placement after decompression(group A),while 34 cases experienced single cage plus unilateral pedicle screw placement(group B).JOA 15 score system were used to evaluate the neurological function(subjective and objective symptom,bladder function)and the excellent rate and improve rate as well as fusion status and cage-related complication were reviewed retrospectively.Result:Preoperative JOA score between two groups showed no significant difference(P>0.05),after an average of 24 months follow-up(range,12-30 months),JOA score between two groups at final follow-up showed remarkable difference(P<0.05),however which had significant difference compared with preoperative counterparts(P<0.01).The improve rate for group A and B was 78.12%and 94.32%,excellent to good rate was 82.14%and 97.06%,bony union rate was 78.57%and 97.06%respectively.Significant difference with respect to improve rate,excellent to good rate and bony union rate between two groups(P<0.05).6 of 28 cases(21.43%)in group A were noted cage related complications(cage prolapsed,displacement and subsidence),while 1 of 34 cases(2.94%)in group B had such complications,which showed significant difference(P<0.05).Conclusion:Single-cage and single cage plus unilateral pedicle screw fixation are both optional for lumbar disc herniation complicated with lumbar instability,however the latter has superior outcome than the former due to higher bony union rate and less instrument related complication.

关 键 词：椎间盘突出症 腰椎不稳症 椎弓根螺钉 椎间融合器 单侧固定 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]