腰椎间融合单侧及双侧内固定术治疗腰椎间盘突出症的对比研究  

Comparative study of unilateral versus bilateral pedicle screw fixation in the treatment of lumbar disc herniation

作　　者：王斌[1] 曾忠友[1] 韩建福[1] 

机构地区：[1]武警浙江总队医院脊柱与关节外科,浙江嘉兴314000

出　　处：《中国矫形外科杂志》2012年第23期2140-2144,共5页Orthopedic Journal of China

摘　　要：[目的]比较分析单侧和双侧椎弓根螺钉内固定术的临床疗效。[方法]回顾分析自2008年3月～2010年2月采用腰椎间融合术治疗的61例腰椎间盘突出症患者,按照手术方式不同分为A、B两组。其中A组28例,男性16例,女性12例;年龄(54.3±9.2)岁,采用经肌间隙入路单侧椎弓根螺钉内固定术治疗。B组33例,男性18例,女性15例;年龄(56.1±7.3)岁,采用传统后正中入路双侧椎弓根螺钉内固定术治疗。分别对两组患者术前和术后随访时的Oswestry功能障碍指数(the Oswestry disability index,ODI)、疼痛视觉模拟评分(visual analoguescale,VAS)、植骨融合率等指标进行观察分析,评价患者的腰椎功能改善情况及手术疗效,并进行两组间的对比分析。[结果]两组病例手术时间、术中出血量、术后切口引流量和住院费用相比差异有统计学意义(P<0.05);所有病例均获随访,A组随访时间25～38个月(平均28.2个月)。B组随访时间24～36个月(平均27.6个月),随访过程中两组病例均未出现螺钉松动、移位、断裂等现象,亦未发现椎间融合器移位或沉陷。两组病例末次随访时VAS评分、ODI评分、术后改善率及融合率均无统计学差异(P>0.05)。[结论]采用单侧椎弓根螺钉内固定术较之采用双侧椎弓根螺钉内固定术可以取得同样满意的临床疗效。且前者具有操作简单、手术时间短、术中出血量少、术后切口引流量少、住院费用低的特点,可以作为治疗单侧腰椎间盘突出症的有效方法。[ Objective ] To compare and analyze the clinical effects of unilateral and bilateral pedicle screw fixation. [ Methods] From March 2008 to February 2010, a total of 61 cases of lumbar disc herniation with treatment of lumbar interbody fusion were divided into group A and B according to different surgical approaches. The 28 cases in group A （ 16 males, 12 fe- males, 54. 3 ± 9.2 years of age） were treated with unilateral pedicle screw fixation by the paramedian approach. The 33 cases in group B （18 males, 15 females, 56. 1 ± 7.3 years of age） were treated with bilateral pedicle screw fixation by the traditional posterior median approach. The parameters including the ODI, VAS scores and fusion rates, etc. were analyzed. The improve- ment in the lumbar spine function and clinical effects of the surgery on the patients in the two groups were also evaluated and compared. [ Results] Statistically significant differences of the operation time, intraoperative blood loss, postoperative flow of incision drain and hospitalization expenses were found between the two groups （ P 〈 0. 05 ） . All the patients were followed up. The follow - up period of the group A ranged from 25 to 38 months （ average 28. 2 months）, and the follow - up period of the group B ranged from 24 to 36 months （ average 27.6 months） . No screw loosening, displacement and breakage were found, and no cage displacement or settlement was observed during the follow - up period. At the final follow - up, no statistical difference of the VAS, ODI score, the excellent and good improvement rate and fusion rate were found between the two groups （ P 〉 0. 05 ） . [ Conclusion] The unilateral pedicle screw fixation can also achieve the satisfactory curative effect compared with the bilateral pedicle screw fixation. In addition, the former has characteristics of simple operative, less operation time, less blood loss, less flow of incision drain and lower hospitalization expenses, which can be the effective treatment for the unilateral lumb

关 键 词：椎弓根螺钉内固定 腰椎间融合 腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]