单侧与双侧椎弓根螺钉固定在治疗极外侧型腰椎间盘突出症的对比研究  

Comparative study of unilateral and bilateral pedicle screws fixation in therapy of far lateral lumbar disc herniation

作　　者：刘夏君[1] 姚福东[1] 王新虎[1] 王建顺[1] 左春光 张国华[1] 杜伟[1] 

机构地区：[1]陕西省宝鸡市中心医院脊柱外科,陕西宝鸡721008

出　　处：《颈腰痛杂志》2016年第3期223-227,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的比较单侧与双侧椎弓根螺钉固定,单枚Cage椎间融合治疗极外侧型腰椎间盘突出症的临床疗效。方法对36例极外侧型腰椎间盘突出症患者随机分组为单侧椎弓根螺钉固定组19例,双侧椎弓根螺钉固定组17例,均行单枚Cage椎间融合固定。记录手术时间、出血量、住院花费、融合率及并发症,临床疗效评估采用腰痛和下肢VAS,JOA评分及ODI指数。所有患者均随访2年。结果两组患者术后腰痛和下肢疼痛VAS、JOA评分及ODI指数较术前明显改善,存在显著性差异。单侧组在术中出血、手术时间及住院花费方面明显少于双侧组。在腰痛VAS、JOA评分及ODI指数方面,单侧组于术后1周、3个月随访时优于双侧组。术后所有患者均骨性融合,2组均未出现钉棒松动及Cage移位。结论单侧椎弓根螺钉固定治疗极外侧型腰椎间盘突出症可取得与双侧椎弓根螺钉固定相同的临床效果,且有效减少手术时间、术中出血及促进早期术后康复,减少住院花费的优点。objective To compare the effects of treatment in far lateral lumbar disc hernia- tion via unilateral or bilateral pedicle screws fixation. Methods Thirty-six consecutive patients were randomly assigned to ether unilateral pedicle screws fixation （n=19） or bilateral pedicle screws fixation（n=17）. The vertebral fusions were performed with one Cage in all patients. Oper- ative time,blood loss,cost of inpatient,fusion rate and complication rate were recorded.low back pain VAS, low leg pain VAS, JOA scores and ODI were used to evaluate for clinical effects. All patients were followed up for two years after operation. Results the both two groups show satisfactory clinical outcome. There are significant differences in low back pain VAS,low leg pain VAS,JOA scores and ODI between pre-operation and post-operation in both two groups. The unilateral group had shorter time, lower blood loss and less cost than bilateral group. The differences were significant. The unilateral group were better than the bilateral group in low back pain VAS,JOA scores and ODI on 1 week after operation and 3 months after operation. Successful radiographic fusions were documented in all patient. During the two years follow-up period,the pedicle screw loosening or breaking and Cage dislocating didn＇t occur. Conclusion the unilateral pedicle screws fixation is no significant difference to the bilateral pedicle fixation in the clinical effects on the therapy of far lateral lumbar disc herniation. But the unilateralgroup had shorter time and lesser blood loss than the bilateral group, the unilateral group is better in rehabilitation on the early period of post-operation and also reduce the patient＇s cost in hospital.

关 键 词：极外侧型腰椎间盘突出症 单侧椎弓根螺钉固定 双侧椎弓根螺钉固定 脊柱后路融 合 临床疗效 

分 类 号：R681.53[医药卫生—骨科学]