单侧与双侧经皮椎弓根固定微创TLIF的比较  

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive tranforaminal lumbar interbody fusion

作　　者：张征石[1] 陈勇[1] 钱红兵[1] 陈吉[1] 汤国庆 

机构地区：[1]南京中医药大学附属昆山医院脊柱骨科,江苏昆山215300

出　　处：《中国矫形外科杂志》2017年第21期1944-1948,共5页Orthopedic Journal of China

摘　　要：[目的]比较微创经椎间孔椎间融合术(MIS-TLIF)单侧与双侧经皮椎弓根螺钉固定治疗单节段腰椎退行性疾病的临床疗效。[方法]回顾性分析本院2012年7月~2015年1月收治的72例应用MIS-TLIF治疗的单节段腰椎退行性疾病患者,其中经皮单侧固定34例,双侧固定38例。观察两种固定方式手术时间、术中出血量、下地活动时间、临床疗效(ODI评分、VAS评分)、并发症发生率、术后2年的椎体间融合情况。[结果]手术时间单侧组少于双侧组[(116.34±34.53)min vs(148.65±42.92)min,P<0.05],术中出血量单侧组少于双侧组[(126.54±21.67)ml vs(153.36±38.24)ml,P<0.05];但术后下地活动时间和住院时间两组差异无统计学意义(P>0.05)。随访时间25~30个月,平均28.5个月。两组的VAS、ODI评分术后2年均较术前显著降低(P<0.05),但相同时间点,两组间差异无统计学意义(P>0.05)。双侧组术后2年融合率(94.73%)优于单纯固定组(76.57%)(P<0.05)。单侧组出现6例继发性脊柱侧弯,而双侧组仅1例发生脊柱侧弯,差异有统计学意义(P<0.05)。[结论]单侧和双侧固定的微创TLIF都有着满意的临床疗效,单侧固定术中出血少,手术时间短,但从长期疗效看双侧固定要优于单侧固定。[Objective] To compare the clinical outcomes of unilateral versus bilateral percutaneous pedicle screw fixa- tion in minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） for single segment lumbar degenerative disease. [Methods] A retrospective study was conducted on clinical data of 72 patients with single segment lumbar degenerative dis- ease received MIS-TLIF surgery. Of them, 34 patients had unilateral pedicle screw fixation （the unilateral group） , while 38 patients received bilateral percutaneous pedicle screw fixation （the bilateral group） . The operation time, intraoperative bleed- ing and ambulation time were recorded, additionally Oswestry Disability Index （ODI）, visual analog scale （VAS） scores, complications as well as fusion rates were assessed. [Results] The unilateral group was inferior to the bilateral fixation group in the operative time [ （116.34＋34.53） min versus 148.65＋42.92） min, P〈0.05] and the blood loss [ （126.54＋21.67） ml vs （153.36＋38.24） ml, P〈0,05] . All the patients were followed up for an average of 28.5 months ranged from 25 to 30 months. At 2 years after operation VAS and ODI statistically decreased compared with those before operation, associated with significant differences between the two time points in both group （P〈0.05） , however, no statistical difference was noted be- tween the two groups at the same time points （P〉O.05） . Furthermore, the fusion rate at two years in the unilateral group was lower than that of bilateral group, with significant difference （76.57%, versus 94.73%, P〈0.05） . Moreover, 6 patients in the unilateral group occurred postoperative scoliosis, whereas only one patient in the bilateral group had the similar change （P〈 0.05） . [Conclusions] Despite of longer operative time and more blood loss, the bilateral fixation achieve more reliable long- term results over the unilateral fixation technique, is the recommended choice for MIS TLIF.

关 键 词：微创 退行性腰椎疾病 椎间融合术 单侧固定 双侧固定 

分 类 号：R687.3[医药卫生—骨科学]