椎弓根螺钉固定联合单枚或双枚椎间融合器治疗腰椎间盘突出症的比较  

Comparison of the curative effects of bilateral pedicle screw fixation with a single Cage or double Cages in treating lumbar disc herniation

作　　者：廖国权[1] 吴健[1] 吴成如[1] 俞军卫[1] 袁伟[1] 高升[1] 

机构地区：[1]解放军第105医院骨二科,安徽合肥230032

出　　处：《颈腰痛杂志》2015年第5期380-384,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨单节段腰椎间盘突出症患者进行椎弓根螺钉固定联合单枚或双枚椎间融合器治疗的疗效差异。方法回顾性分析解放军第105医院在2010-01-2012-01进行双侧椎弓根螺钉固定联合椎间融合器的87例单节段腰椎间盘突出症患者临床及影像学资料。A组采用双侧椎弓根螺钉固定联合单枚椎间融合器治疗,B组联合双枚椎间融合器。按日本骨科学会(JOA)1984年制定的腰腿痛疗效标准分别对患者进行治疗前和治疗后的随访评分,计算治疗后的改善率和优良率;测量椎间隙高度变化并按Suk标准评定椎间融合率。按以上标准对两组患者进行比较研究。结果 A组手术时间、术中出血量及住院费用低于B组,差异有统计学意义(P<0.05),两组住院时间比较无明显差异;两组患者治疗后JOA评分显著升高(P<0.05),但组间对比无明显差异;随访24个月时,B组椎间隙高度丢失明显低于A组(t=24.190;P<0.05),但两组椎间融合率无明显差异。两组的手术并发症情况无明显差异。结论应用双侧椎弓根螺钉固定联合单枚与双枚椎间融合器治疗单节段腰椎间盘突出患者疗效及椎间融合率相当,使用单枚椎间融合器手术时间更短、出血量更少且患者经济负担更小,但采用双枚椎间融合器患者的椎间隙高度丢失低于单枚椎间融合器。Objective To explore the difference of curative effects between bilateral pedicle screw fixation with a single Cage and double Cages in treating lumbar disc herniation. Methods The clinical and imaging data of 87 patients with single-level lumbar disc herniation, who re- crnited in our hospital from January 2010 to January 2012 and treated with bilateral pedicle serew internal fixation and lumbar interbody fusion, were retrospectively analyzed. These patients were divided into two groups： 53 patients in group A performed single Cage, while 34 patients in group B performed bilateral Cages. The neurological function of patients was assayed by Japanese Orthopaedic Association（JOA） score system before and after treatment, the improvement rate and excellent/good rate were calculated. The loss of intervertebral height was measured and Suk criterion was used to determine fusion status. Results The least follow-up period was 24 months for 87 patients. The operation time, amount of bleeding during the operation and hospi- talization expenses of group A were lower than those of group B, there were significant differ- ences（t=7.556, t=8.670,=3.864;P〈0.05）, the two groups had no significant difference in hospital- ization period. The JOA score after 24 months of treatment was significantly higher than that be- fore treatment （t=17.576, t=12.559; P〈0.05） in both two groups, but the difference between the two groups was not statistically significant. The loss of intervertebral height occurred in both two groups, while that in group .A was more significant than that in group B （t=24.190;P〈0.05）. But there was no significant difference in fusion effect. Conclusion Our findings indicate that sin- gle-cage lumbar interbody fusion or double-cages combined with bilateral pedicle screw fixation provides similar satisfactory effects and fusion rate in treating single-level lumbar disc herniation. While the former has shorter operation time,less blood loss and smaller economic burden, the later has smaller loss

关 键 词：腰椎间盘突出症 椎弓根螺钉固定 单枚 双枚 椎间融合器 

分 类 号：R681.53[医药卫生—骨科学] R687.32[医药卫生—外科学]