单侧与双侧椎弓根固定椎间融合术治疗双节段腰椎间盘突出症的疗效比较  

Comparison of unilateral and bilateral pedicle fixation in interbody fusion for bilateral lumbar disc herniation

作　　者：戴春美[1] 徐卫星[1] 俞雷钧[1] 丁伟国[1] 王健[1] DAI Chunmei;XU Weixing;YU Leijun(Department of Orthopedics,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院骨伤科,杭州310012

出　　处：《浙江医学》2020年第6期575-579,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY508)。

摘　　要：目的探讨单侧与双侧椎弓根固定椎间融合术治疗双节段腰椎间盘突出症的疗效。方法选取双侧椎弓根固定椎间融合术治疗双节段腰椎间盘突出症患者(对照组)和单侧椎弓根固定椎间融合术治疗双节段腰椎间盘突出症患者(研究组)各53例。比较两组患者围术期情况,术前及术后第1天、1个月、2个月视觉模拟评分法(VAS)评分,术前及术后6个月Oswestry功能障碍指数(ODI)及日本骨科协会评估治疗评分(JOA),术前及术后6个月腰椎前后凸角,并发症发生情况。结果研究组术中失血量、术后引流量均少于对照组,手术时长、卧床时间、住院时长均短于对照组,两组比较差异均有统计学意义(均P<0.01)。术后第1天、1个月、2个月两组VAS评分均较术前降低,且研究组VAS评分均低于对照组,差异均有统计学意义(均P<0.05)。术后6个月两组ODI均较术前降低,JOA评分均较术前升高,腰椎前凸角均较术前增大,后凸角均较术前减小,差异均有统计学意义(均P<0.05)。研究组并发症发生率为5.66%,低于对照组的18.87%,两组比较差异有统计学意义(P<0.05)。结论双节段腰椎间盘突出症椎间融合术中应用单侧和双侧椎弓根固定,均可改善患者腰椎前后凸角,恢复其腰椎功能,但单侧椎弓根固定在减少手术创伤方面更具优势,患者术后疼痛感减轻,且并发症发生率较低,安全性较高。Objective To compare the efficacy of unilateral and bilateral pedicle fixation in interbody fusion for bilateral lumbar disc herniation.Methods One hundred and six patients with dual-segment lumbar intervertebral disc herniation undergoing interbody fusion surgery,including 53 cases with the bilateral pedicle fixation(control group)and 53 cases with unilateral pedicle fixation(study group).The perioperative status,VAS pain scores before and after operation,Oswestry dysfunction index(ODI)scores before and 6 months after operation,JOA scores,lumbar lordosis angle and kyphosis angle,and the incidence of complications were compared between two groups.Results The blood loss during the operation and postoperative drainage in the study group were less than those in the control group(both P<0.01).The length of operation,bed time and length of hospital stay in study group were shorter than those in the control group(all P<0.01).On the first day,1 month,and 2 months after surgery,the VAS pain scores in both groups were lower than those before surgery,and the VAS pain scores of the study group were lower than those of the control group(all P<0.05).At 6 months after surgery,the ODI scores in both groups were lower than those before surgery;the JOA scores were higher than those before surgery;the lumbar lordosis angle was larger than before surgery,and the kyphosis angle was smaller than that before surgery(all P<0.05).The incidence of complications in the study group was 5.66%,which was lower than that in the control group(18.87%,P<0.05).Conclusion The application of unilateral and bilateral pedicle fixation in double-level lumbar intervertebral disc fusion can improve the lumbar lordosis and restore the lumbar function.However,unilateral pedicle fixation has advantages of less surgical trauma and postoperative pain with lower incidence of complications and higher safety for patients with bilateral lumbar disc herniation.

关 键 词：椎弓根固定 椎间融合手术 双节段腰椎间盘突出症 腰椎前后凸角 

分 类 号：R687.3[医药卫生—骨科学]