单侧与双侧椎弓根螺钉固定对行TLIF治疗的腰椎退行性病变患者的效果比较  

Effect analysis of unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in patients with lumbar degenerative disease

作　　者：汤旭日[1] 马安军[1] 傅弛 叶必谦[1] 李兴中[1] 吴恙[1] 

机构地区：[1]金华市中心医院骨科,浙江金华321000

出　　处：《中华全科医学》2017年第6期965-967,共3页Chinese Journal of General Practice

基　　金：浙江省金华市科技局项目(2014-3-050)

摘　　要：目的探讨单侧与双侧椎弓根螺钉固定联合经椎间孔椎间融合术(TLIF)的治疗效果,旨在探索出治疗腰椎退行性病变更有效的治疗方法,为临床治疗提供依据。方法回顾性分析2010年10月—2014年6月于金华市中心医院采用单侧或双侧椎弓根螺钉联合经椎间孔椎间融合术治疗的117例腰椎退行性疾病患者临床资料,其中单侧固定者56例,双侧固定者61例,所有患者获2年以上随访。比较2组患者手术时间、术中失血量,并通过影像学评估腰椎融合情况、并发症、相邻节段退变及腰椎Cobb角变化。结果单侧固定组手术时间、术中出血量均明显少于双侧固定组(P<0.05);术后6个月、术后1年、术后2年2组的融合率差异无统计学意义(P>0.05);两组均未见严重并发症,末次随访时,单侧相邻节段退变率为33.93%,双侧固定组相邻节段退变率为65.57%,单侧固定组相邻阶段退变率明显低于双侧固定组(P<0.05);2组在术毕、术后3个月、术后6个月、术后2年腰椎Cobb角的差异均无统计学意义(P>0.05)。结论单侧与双侧椎弓根螺钉固定行TLIF术,均可获得满意的治疗效果,但单侧椎弓根螺钉固定手术时间短,术中失血量少,相邻节段退变发生率明显更低。Objective To investigate the effect of unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in patients with lumbar degenerative disease,aims to explore the treatment of lumbar retrograde changes effective treatment,to provide basis for clinical treatment. Methods A total of 117 lumbar degenerative disease patients were divided into unilateral fixation group（ 52 cases） and bilateral fixation group（ 52 cases） from October,2010 to June,2014. All patients were followed up for more than 2 years. To compare operation time,intraoperative blood loss,lumbar spine fusion,complications,degeneration of adjacent segments and Cobb angle of lumbar vertebrae in 2 groups.Results The operation time and intraoperative blood loss of unilateral fixation group were significantly less than those in bilateral fixation group（ P〈0. 05）; There was no significant difference in fusion rate between 2 groups at 6 months,1 year and 2 years after operation（ P〈0. 05）. There was no serious complication in the two groups. At the last follow-up,the degeneration rate of adjacent segments of unilateral fixation group was 33. 93%,and the degeneration rate of adjacent segments of bilateral fixation group was 65. 57%,the degeneration rate of adjacent segments of unilateral fixation group was lower than that in bilateral fixation group（ P〈0. 05）,and the rate was significantly lower than that of bilateral fixation group（ P〈0. 05）; There was no significant difference in the Cobb angle between 2 groups at end of operation,3 months after operation,6 months after operation and 2 years after operation（ P〈0. 05）. Conclusion Unilateral and bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in patients with lumbar degenerative disease,can obtain satisfactory treatment,but unilateral pedicle screw fixation has short,operation time,little blood loss,adjacent segment degeneration was significantly more low.

关 键 词：腰椎退行性病变 椎间孔椎间融合术 单侧 双侧 内固定 

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