正中旁入路单侧椎弓根螺钉内固定术治疗腰椎间盘突出伴腰椎不稳症

Paramedian Approach with Unilateral Pedicle Screw Fixation for Lumbar Disc Herniation Combined with Lumbar Instability

目的:探讨正中旁入路单侧椎弓根螺钉内固定术治疗腰椎间盘突出合并腰椎不稳症的疗效。方法:2007年2月8—2009年3月33例腰椎间盘突出合并腰椎不稳症的患者(男性20例,女性13例;年龄35～52岁,平均年龄40.5岁),采用正中旁入路单侧椎弓根螺钉内固定术治疗。对术前和术后随访时的日本骨科协会评估治疗分数(JOA)评分、疼痛视觉模拟评分(VAS)、植骨融合率进行观察分析,并评价患者的腰椎功能改善情况及手术疗效。结果:手术时间为(110±16.8)min,术中出血量为(206±40.1)mL。患者随访时间平均为26.7个月。JOA评分术前平均为(8.1±0.9)分,术后末次随访时为(14.2±0.5)分,术后平均改善率为88.4%,其中优级改善率(75%～100%)31例(93.9%),良级改善率(50%～74%)1例(3.0%),可级改善率为(25%～49%)1例(3.10%)。优良率为96.9%。VAS评分术前为(7.9±0.4)分,术后末次随访时为(1.9±0.5)分.下降了75.9%。所有患者随访期间X线检查提示椎间融合器无移位及沉降,内固定无松动、断裂等,椎间植骨均获得骨性融合,植骨融合率为100%。所有病例末次随访时JOA评分及VAS评分与术前比较差异均有统计学意义(P<0.05)。结论:采用正中旁入路单侧椎弓根螺钉内固定治疗腰椎间盘突出合并腰椎不稳症效果优良,具有操作简单、创伤小的特点,可有效改善患者的临床症状,促进神经功能的恢复。

Objective：To discuss the clinical effects of the paramedian approach with unilateral pedicle screw fixation on the lumbar disc herniation combined with lumbar instability.Methods：From February 2007 to March 2009,a total of 33 cases（20 males,13 females, 35-52 years of age,average 40.5 years） of lumbar disc herniation combined with lumbar instability were treated with unilateral pedicle screw fixation by the paramedian approach.The Japanese Orthopaedic Association（JOA） and visual analogue scale（VAS） scores before and after surgery and the fusion rate were analyzed during the follow-up period.The improvement in the lumbar spine function and clinical effects of the surgery on the patients were also evaluated.Results：The average operation time and blood loss were （11（1±16.8）min and（206±40.1 ）mL respectively.The average follow-up period of the patients was 26.7 months.The average preoperative JOA score was（8.1±0.9） and the average JOA score at the last follow-up was（14.2±0.5）.The average postoperative improvement rate was 88.4%with 31 cases of excellent improvement rate（93.9%）,1 case of good improvement rate（3.0%） and 1 case of fair improvement rate（3.0%）.The excellent and good improvement rate was 96.9%.The preoperative VAS score was（7.9±0.4） and the VAS score at the last follow-up was（1.9±0.5） with a 75.9 precent decrease.No cage displacement or settlement and implant loosening or breakage in this group were found by the radiological examination during the follow-up period,and bony fusion was achieved in all patients with a 100 percent fusion rate.Statistical analysis revealed significant differences（P〈0.05） between the preoperative JOA or VAS scores and the JOA or VAS scores at the last follow-up.Conclusions：Good clinical outcomes in the treatment of the lumbar disc herniation combined with lumbar instability are achieved using the paramedian approach with unilateral pedicle screw fixation.This technique has advantages of less trauma and easy manipulation,can effectively alleviate the patients＇ symptoms and advance the neural functional recovery.