改良经椎间孔腰椎椎体间融合术联合单侧椎弓根螺钉内固定的中长期疗效  

Medium-and long-term clinical efficacy of modified transforaminal lumbar interbody fusion combined with unilateral pedicle screw internal fixation

作　　者：高鑫 费燕强[1] 蒋文超 厉晓龙[1] GAO Xin;FEI Yanqiang;JIANG Wenchao(Department of Spinal Surgery,Affiliated Wujin Hospital,Jiangsu University,Changzhou 213017,CHINA)

机构地区：[1]江苏大学附属武进医院(徐州医科大学武进临床学院)脊柱外科,江苏常州213017

出　　处：《江苏医药》2020年第10期1048-1051,1055,共5页Jiangsu Medical Journal

基　　金：常州市武进区科技支撑计划(WS201807)。

摘　　要：目的观察改良经椎间孔腰椎椎体间融合术(TLIF)联合单侧椎弓根螺钉内固定的中长期临床疗效。方法62例无邻近节段退变的腰椎间盘突出症患者,30例运用改良TLIF联合单侧椎弓根螺钉内固定(A组),32例运用改良TLIF联合双侧椎弓根螺钉内固定(B组)。随访两组患者术后6~9年的VAS疼痛评分、融合节段术后与术前多裂肌横截面积(MF-csa)比值和融合邻近节段三维有限元生物力学相关指标。结果B组1例患者失访,其余61例患者融合节段均达到骨性融合,椎间融合器无移位及沉降,内固定无松动、断裂、拔出等并发症发生。A、B组患者下腰部VAS疼痛评分无统计学差异[(2.2±1.8)分vs.(2.7±2.1)分](P>0.05)。A组融合节段术后与术前MF-csa比值高于B组[(92±8)%vs.(80±9)%](P<0.05)。两组邻近节段L3~L4活动范围在前屈、后伸、侧屈和扭转4种状态下角位移比较均无统计学差异(P>0.05)。结论短节段腰椎间盘突出症患者采用改良TLIF联合单侧椎弓根螺钉固定在术后中长期融合状态、临床功能方面与双侧椎弓根螺钉固定的疗效相当,并能减少背部多裂肌萎缩。Objective To observe the medium-and long-term clinical efficacy of modified transforaminal lumbar interbody fusion(TLIF)combined with unilateral pedicle screw fixation.Methods Of 62 patients with lumbar disc herniation without adjacent segment degeneration,30 patients were treated by modified TLIF combined with unilateral pedicle screw fixation(group A)and 32 patients were treated by modified TLIF combined with bilateral pedicle screw fixation(group B).VAS pain score,the ratio of cross-sectional area of multifidus muscle(MF-csa)in fusion segments after operation to that before operation,and three-dimensional finite element biomechanical parameters of adjacent segments were followed up for 6-9 years in both groups.Results One patient in group B lost follow-up,the fusion segments of the other 61 patients achieved bony fusion,in whom there was no displacement or settlement of interbody fusion cage,and there were no complications such as loosening,fracture and pullout of internal fixation.There was no significant difference in VAS score of lower waist between groups of A and B[(2.2±1.8)points vs.(2.7±2.1)points](P>0.05).The ratio of MF-csa in fusion segments after operation to that before operation in group A was higher than that in group B[(92±8)%vs.(80±9)%](P<0.05).There was no significant difference between the two groups in the angular displacement in the range of L3-L4 activity of the adjacent segments under four states of forward bending,backward stretching,lateral bending and torsion(P>0.05).Conclusion Modified TLIF combined with unilateral pedicle screw fixation in the patients with short segment lumbar disc herniation has the same clinical efficacy as bilateral pedicle screw fixation in postoperative medium-and long-term fusion state and clinical function,and can reduce back multifidus muscle atrophy.

关 键 词：腰椎椎体间融合术 椎弓根螺钉 

分 类 号：R681[医药卫生—骨科学]