单侧、双侧内固定联合经椎间孔椎间融合对腰椎术后假关节形成及腰椎活动的影响  

Comparison of the incidence of pseudarthrosis and its effects on lumbar motion after unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in degenerative lumbar diseases

作　　者：周恒才[1] 马超[1] 夏计划[1] 冯杰[1] 拾坤[1] 张建伟 刘光旺[1] 张兆川[1] Zhou Hengcai;Ma Chao;Xia Jihua;Feng Jie;Shi Kun;Zhang Jianwei;Liu Guangwang;Zhang Zhaochuan(Department of Spine Surgery,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院脊柱外科,徐州221009

出　　处：《中华解剖与临床杂志》2021年第5期543-548,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨后路单侧、双侧内固定联合经椎间孔椎间融合术(TLIF)治疗单节段腰椎退行性病变术后假关节的发生及其对腰椎活动的影响。方法回顾性队列研究。纳入2009年1月—2015年5月徐州市中心医院121例腰椎退行性病变患者的临床资料,其中男45例、女76例,年龄40~70(50.8±6.8)岁。根据手术方式的不同分为两组,腰椎后路单侧固定联合TLIF术组(单侧固定组)48例,腰椎后路双侧固定联合TLIF术组(双侧固定组)73例。根据术前及末次随访时腰椎动力位X线片,测量腰椎融合节段(L4/5)、融合节段上邻近节段(L3/4)和下邻近节段(L5/S1)以及全腰段的腰椎运动范围(ROM)。采用视觉模拟评分法(VAS)评估患者腰痛情况,Oswestry功能障碍指数(ODI)评价疗效,采用腰椎CT评估两组患者椎间融合情况。(1)比较单侧组与双侧组患者的临床基线资料;(2)比较两组术后假关节发生率、假关节翻修率;(3)比较单侧组与双侧组患者术前及末次随访的临床疗效;(4)比较两组无假关节者间,以及单侧组内假关节者与无假关节者间,术前与末次随访的影像学参数及腰痛VAS评分和ODI。结果两组患者临床基线资料比较,差异均无统计学意义(P值均>0.05)。两组患者均顺利完成手术,术后随访2~8年。术后单侧内固定组假关节发生率18.6%(9/48),假关节翻修率12.5%(6/48)均高于双侧内固定组的5.5%(4/73)、1.4%(1/73),差异均有统计学意义(χ2=4.024、4.698,P值均<0.05)。单侧组与双侧组患者术前及末次随访术后腰痛VAS评分、ODI比较,差异均无统计学意义(P值均>0.05)。单侧固定组、双侧固定组无假关节者间比较,术前、末次随访时L4/5、L3/4和L5S1以及全腰段的腰椎ROM以及腰痛VAS评分、ODI的差异均无统计学意义(P值均>0.05)。单侧固定组内:末次随访时假关节者VAS评分、ODI均大于无假关节者,L3/4 ROM小于无假关节者,差异均有统计学意义(P值均<0.05);末次随Objective To evaluate the incidence of pseudarthrosis and its effects on lumbar motion after unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF)in degenerative lumbar diseases.Methods A retrospective cohort study was conducted among 121 patients with single-segment degenerative lumbar disease treated with unilateral or bilateral pedicle screw fixation combined with TLIF.The patients were divided into the unilateral(n=48)and bilateral groups(n=73).Ranges of motion(ROM)in the fixed segment(L4/5),upper adjacent segment(L3/4),lower adjacent segment(L5/S1),and full lumbar segment were measured based on flexion-extension films.Visual analog scale(VAS)and Oswestry disability index(ODI)scores were used to evaluate clinical efficacy,and computed tomography was used to assess interbody fusion.This study compared:(1)the baseline data,the number of cases with pseudarthrosis after surgery,and the number of cases requiring revision due to pseudarthrosis between the two groups;(2)the clinical efficacy before operation and at the final follow-up between the two groups;(3)the imaging parameters,VAS score,and ODI score before surgery and at the last follow-up among the cases of the two groups without pseudarthrosis and among the cases in the unilateral group with and without pseudarthrosis.Results No significant difference in clinical baseline data was found between the two groups(all P values>0.05).The unilateral group had a pseudarthrosis incidence of 18.6%(9/48)and a pseudarthrosis revision rate of 12.5%(6/48),which were higher than those in the bilateral group(5.5%[4/73]and 1.4%[1/73],respectively).The differences were statistically significant(χ2=4.024,4.698;all P values<0.05).No significant differences in VAS and ODI scores were found between the two groups before surgery and at the final follow-up(all P values>0.05).No significant differences were found in the ROMs of L4/5,L3/4,L5S1,and the whole lumbar segment,as well as in the VAS and ODI scores,before surgery and at the f

关 键 词：脊柱融合术 腰椎 椎间孔椎间融合术 内固定术 假关节 

分 类 号：R687.3[医药卫生—骨科学]