单侧椎弓根螺钉内固定椎间融合治疗腰椎退行性病变临床研究

Unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disease

目的评估单侧椎弓根螺钉内固定(unilateral pedicle screw fixation,Ups)结合经椎间孔椎间融合(transforaminallumbar interbody fusio,TLIF)治疗腰椎退行性疾病的临床疗效。方法 2009年12月至2010年12月,共收治不同类型腰椎退行性疾病患者42例,按照自愿的原则,采用Ups结合TLIF治疗24例和双侧椎弓根螺钉内固定术结合椎间融合术治疗18例。应用视觉模拟评分系统(Visual Analog Scale,VAS)评估患者术前、术后疼痛情况,应用Kim方法评价临床效果,应用Schulte方法观察植骨融合情况。结果所有患者术后临床症状较术前明显改善、临床疗效良好,无并发症的发生。VAS评分、Kim评分单侧固定优于双侧固定,Schulte方法观察植骨融合2组无显著差异。随访时间6～18个月,平均12.8个月。结论 Ups结合TLIF在治疗腰椎退行性疾患时具有微创手术的优点,疗效明确,但需严格把握手术适应证。

Objective This study aimed to investigate the clinical outcome of unilateral pedicle screw(Ups) fixation and transforaminal lumbar interbody fusion(TLIF) in the treatment of lumbar degenerative disease.Methods Forty-two patients with lumbar degenerative disease were assigned to two groups on a voluntary basis to receive Ups+TLIF(n=24) and bilateral pedicle screw fixation combined with fusion between vertebra(n=18).Pre-and post-operative back pains were compared using the visual analog scale(VAS) system,the clinical outcomes assessed by the Kim method,and the fusion status evaluated by the Schulte method.Results The clinical symptoms of all the patients were improved post-operatively,with no complications.The Ups+TLIF group showed higher VAS and Kim scores than the bilateral fixation group,but no significant differences were observed in the bone graft fusion between the two groups.The patients were followed up for 6 to 18(mean 12.8) months.Conclusion Ups+TLIF,characterized by minimal invasiveness,is a reliable and effective option for the management of lumbar degenerative disease.However,its indications should be well considered.