两种方式经椎间孔椎间融合与椎弓根内固定治疗极外侧腰椎间盘突出症的疗效比较  

Comparative efficacy of unilateral transforaminal lumbar interbody fusion with a single-cage and bilateral pedicle internal fixation in the treatment of extreme lateral lumbar disc herniation

作　　者：王震[1,2] 张喜善[1] 

机构地区：[1]泰山医学院附属医院骨一科,山东泰安271000 [2]新汶矿业集团华丰煤矿医院骨科,山东宁阳271413

出　　处：《中国矫形外科杂志》2014年第11期982-984,共3页Orthopedic Journal of China

摘　　要：[目的]探讨单侧经椎问孔单个Cage融合术联合单侧椎弓根内固定与联合双侧椎弓根内固定打压植骨融合术治疗极外侧腰椎间盘突出症的近期临床疗效。[方法]选择2009年4月～2012年10月本院收治的极外侧腰椎间盘突出症患者37例，将其随机分为单侧组20例、双侧组17例，比较两组患者手术时间、术中出血量、下床时间以及住院费用，并对患者进行随访。[结果]单侧组患者比双侧组患者手术时间短、术中出血量少、住院费用低，差异具有统计学意义（P〈0．05）；组间比较，两组患者术前VAS评分以及术后3个月VAS评分均无显著性差异（P〉0．05）；组内比较，单侧组术后3个月VAS评分显著低于术前评分（P〈0．05），双侧组术后3个月VAS评分显著低于术前评分（P〈0．05）；术后随访37例患者手术切口均一期愈合，术后均未发现Cage下陷，其内置物未发生断裂、松动移位，患者均无假关节形成。[结论]联合单侧椎弓根内固定单个Cage融合术较联合双侧椎弓根内固定打压植骨融合术其近期效果显著，缩短手术时间、减少术中出血量并减少住院费用；长期结果来看，两种手术方法都是安全有效的。[Objective] To compare the short- term clinical effects of unilateral transforaminal lumbar interbody fusion （TLIF） with a single -cage and bilateral pedicle internal fixation in the treatment of extreme lateral lumbar disc herniation. [ Methods] We selected patients who were admitted to our hospital with extreme lateral lumbar disc herniation between April 2009 and October 2012. A total of 37 cases were included in this study and randomly divided into two groups according to the sur- gical intervention： 20 unilateral TLIF cases and 17 bilateral pedicle internal fixation cases. The two groups were compared in terms of surgery duration, intraoperative bleeding volume, duration of bed confinement, and cost of hospitalization. The patients were followed up after the surgery. [ Results ] The patients in the unilateral fixation group had shorter surgery duration, less bleeding, and lower hospitalization costs than those in the bilateral fixation group, with a statistically significant difference （ P 〈 0. 05 ）. The comparison of the visual analog scale （VAS） scores before and three months after surgery showed no significant difference between the groups （ P 〉 0. 05 ） ; the within - group comparisons indicated that in both groups, the VAS score three months after the surgery was significantly lower than the preoperative VAS score （ both P 〈 0. 05 ） . During the postoperative fol- low - up, primary healing of the surgical incision was observed in all 37 patients ; implant loosening, dislocation, and pseudar- throsis were not encountered. [ Conclusion] Unilateral pedicle screw fixation combined with single - cage fusion fixed with bi- lateral pedicle bone grafting fusion shortened surgery duration and reduced bleeding as its short - term effects, and reduced hos- pitalization costs as its long- term effect. Nevertheless, both surgical methods may be considered safe and effective.

关 键 词：极外侧腰椎间盘突出 单侧经椎间孔融合术 椎弓根内固定 

分 类 号：R687.3[医药卫生—骨科学]