单侧与双侧椎弓根螺钉固定结合TLIF治疗老年退行性腰椎疾患的临床研究  

Clinical efficiency of unilateral vs bilateral pedicle screws system combined with TLIF for lumbar degenerative disease in elderly patients

作　　者：李华[1] 杨维杰[1] 田建平[1] 张凯[1] 赵鑫[1] 赵长清[1] 赵杰[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,200011

出　　处：《中华老年骨科与康复电子杂志》2016年第4期205-210,共6页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：上海市卫生系统重要疾病联合攻关项目(2013ZYJB0502)

摘　　要：目的 探讨单侧与双侧椎弓根螺钉固定结合经椎间孔椎体间植骨融合术（TLIF）治疗老年腰椎退行性疾病的临床疗效及手术安全性。方法 回顾性分析2012年1月至2013年5月上海交通大学第九人民医院收治的采用单侧或双侧椎弓根螺钉固定结合TLIF治疗的31例腰椎退行性疾病患者的临床资料。根据手术方式， 将患者分为单侧固定组（n=19）和双侧固定组（n=12）。比较分析两组患者术前和术后疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）、 手术时间、 术中出血量、 术后并发症、 椎间隙高度变化、 椎间融和率。结果 所有病例均获成功随访， 随访时间为24～36个月， 平均（29±3）个月。单侧固定组和双侧固定组患者的 VAS评分（F=55.992， P＜0.01）、 ODI（F=42.755， P＜0.05）和椎间隙高度变化（F=13.632， P＜0.05）等术后 6个月及 24个月较术前均有明显改善， 但组间比较差异均无统计学意义。单侧固定组的手术时间、 术中出血量明显优于双侧组， 差异具有统计学意义（t=2.412， P＜0.05； t=2.235， P＜0.05）。末次随访时两组间融合节段沉降率比较差异无统计学意义。单侧组并发症患者5例（26.3%）， 双侧组3例（25.0%）， 两组各有1例未达到骨性融合。结论 与双侧固定相比， 单侧椎弓根螺钉固定结合TLIF治疗老年腰椎退行性疾病的临床疗效相当， 但具有手术创伤小、 手术时间短、 术中出血量少等优点。Objective To investigate the clinical outcomes and safety between unilateral and bilateral pedicle screw system with transforaminal lumbar interbody fusion(TLIF) for lumbar degenerative disease in elderly patients. Methods Retrospectively analysis were performed in the clinical data of 31 patients with lumbar degenerative disease treated with pedicle screw fixation and TLIF in Shanghai Ninth People's Hopital from January 2012 to May 2013. There were 16 males(51.6%) and 15 females(48.4%), the average age was72±5 years(range, 65-86 years). Patients were divided into unilateral group(n=19) and bilateral group(n=12)according to the different fixation. Comparison of the preoperative and postoperative visual analogue scale(VAS) scores of back pain and Oswestry disability index(ODI), operation time, intraoperative blood loss,complication, height of the intervertebral space and fusion rate were done between two groups. Results All patients received an average of 29 ± 3 month of follow- up(range, 24- 36 m). Both group achieved significant improvements on VAS(F=55.992, P<0.01), ODI(F=42.755, P<0.05) and the height of intervertebral space(F=13.632, P<0.05) in postoperative 6 month and 24 month compare to the initial data, but parallel comparison between two groups showed no statistical difference. The operation time, intraoperative blood loss in unilateral group were superior than the bilateral group with satatistical significance(t=2.412, P<0.05;t=2.235, P<0.05). No difference of the postoperative subsidence rate was observed between two groups(F=0.673, P=0.523). Five cases(26.3%) associated with complications in unilateral group and 3 cases(25.0%)in bilateral group, and one non- union in each group. Conclusions Comparable good clinical and radiographic outcomes can be achieved using TLIF comnbined with unilateral and bilateral pedicle screw fixation for the treatment of elderly lumbar degenerative diseases. But the unilateral pedicle screw fixation sustain more advantages, less surgical trauma, operation time and intrao

关 键 词：老年人 腰椎 脊柱融合术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]