经单侧减压融合、单边椎弓根螺钉内固定治疗腰椎退变性疾病  

Treatment of Lumbar Degenerative Disease with Unilateral Decompression,Bone Graft Fusion and Unilateral Pedicle Screw Fixation

作　　者：宋晋刚[1] 崔易坤[1] 苗艳[2] 尹振宇[1] 羊刚毅[1] 黄海锋[1] 

机构地区：[1]四川省绵阳市中心医院脊柱外科,绵阳621000 [2]四川省绵阳市人民医院康复科,绵阳621000

出　　处：《中国微创外科杂志》2016年第5期441-444,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经单侧行病变节段椎管减压、椎间植骨融合、单边椎弓根螺钉内固定治疗腰椎退变性疾病的临床疗效。方法我院2010年1月~2013年12月对35例腰椎退变性疾病采用经单侧减压、椎间植骨融合、单边椎弓根螺钉固定手术治疗。根据JOA评分法评估术后腰椎功能改善情况,采用视觉模拟评分（visual analog scale,VAS）评估术后疼痛缓解情况,腰椎正侧位X线片及CT扫描了解植骨融合情况。结果随访12~18个月,平均15个月。术前JOA评分（8.2±2.1）分,显著低于术后3个月（20.8±3.8）分（q=22.123,P〈0.05）和术后12个月（21.7±3.9）分（q=23.703,P〈0.05）;VAS评分术前（7.9±2.1）分,显著高于术后3个月（2.4±0.4）分（q=26.107,P〈0.05）和12个月（2.3±0.3）分（q=26.582,P〈0.05）;JOA评分和VAS评分随访期间无显著变化（P〉0.05）。1年后椎间植骨融合率100%,未发现椎弓根螺钉松动、断裂、拔钉等异常。结论经单侧减压、椎间植骨融合联合单边椎弓根螺钉内固定治疗腰椎退变性疾病疗效满意,可在合适病例中推广应用。Objective To investigate the clinical effects of unilateral vertebral canal decompression,intervertebral bone graft fusion,and unilateral pedicle screw fixation in the treatment of lumbar degenerative disease. Methods From January 2010 to December 2013,a total of 35 cases of lumbar degenerative disease were treated with unilateral decompression,intervertebral bone graft fusion,and unilateral pedicle screw fixation. The postoperative spine functions were evaluated with the JOA scores,the postoperative pain relief was evaluated with the VAS scores,and bone graft fusion was reviewed with lumbar X-ray and CT scanning. Results The patients were followed up for 12- 18 months（ mean,15 months）. The preoperative JOA scores（ 8. 2 ± 2. 1 points） were significantly lower than 3 months after operation [（ 20. 8 ± 3. 8） points,q = 22. 123,P〈0. 05] and 12 months after operation（ 21. 7 ± 3. 9 points,q = 23. 703,P〈0. 05）. The preoperative VAS scores（ 7. 9 ± 2. 1） points were significantly higher than postoperative 3 months[（ 2. 4 ± 0. 4） points,q = 26. 107,P〈0. 05]and 12 months [（ 2. 3 ± 0. 3） points,q = 26. 582,P〈0. 05]. There was no significant difference（ P〉0. 05） for JOA scores and VAS scores during the follow-up period. The 1-year intervertebral bone graft fusion rate was100%. No pedicle screw loosening,fracture,or nail abnormalities was found. Conclusion The unilateral decompression,intervertebral bone graft fusion combined with unilateral pedicle screw internal fixation in the treatment of lumbar degenerative disease is satisfactory and suitable for clinical application.

关 键 词：椎弓根内固定 脊柱融合术 腰椎间盘突出症 脊柱退变 

分 类 号：R687.3[医药卫生—骨科学]