单枚Cage结合单侧椎弓根固定治疗32例腰椎退变性疾病疗效观察

Clinical research of single cage plus unilateral pedicle screw fixation for the treatment of 32 patients with lumbar degenerative instability

目的探讨单枚Cage结合单侧椎弓根螺钉固定治疗腰椎退变性疾病患者的疗效。方法对32例腰椎退变性疾病患者采用减压后单枚Cage单侧椎弓根固定术。根据JOA评分法评估术后优良率,VAS评估术后疼痛缓解情况。结果 32例均获随访,时间3～24(13±3.7)个月。JOA评分:术前为2～6(4±2.1)分,术后3个月时为8～14(11±1.8)分。术后平均改善率为(81.23±8.71)%,其中优27例,良3例,可1例,差1例,优良率为93.75%。VAS分值:术前为(6.94±0.91)分,术后1个月时为(2.31±0.82)分,末次随访时为(2.16±0.68)分,术后及末次随访时较术前均有明显改善(P<0.05)。椎间植骨融合率94%。未发现椎弓根螺钉松动、拔出、断钉及Cage移位。结论单枚cage结合单侧椎弓根固定治疗腰椎退变性疾病能获得满意的临床疗效。

Objective To explore the clinical outcome of single cage plus unilateral pedicle screw fixation for the treatment of lumbar degenerative instability. Methods 32 patients of lumbar degenerative instability were undergone unilateral pedicle screw fixation plus single cage interbody fusion. The clinical outcome was assessed by JOA score system. VAS system was used to evaluate the pre- and post-operative back pain. Results All cases were followed up for 3 -24 （13 ± 3.7 ） months. The average JOA scores at preoperation and 3 months follow-up was 2 -6 （4 ± 2. 1 ） and 8 - 14 （ 11 ±1.8 ） respectively. The average improvement rate of postoperation was （81.23 ± 8.71 ）%. 27 cases were rated as excellent,3 good, 1 fair and 1 poor, with the total excellent and good rate of 93.75%. The VAS was 6. 94 ±0. 91 at preoperation,2. 31 ±0. 82 at one month after operation,and 2. 16 -0. 68 at the last follow-up, and there were statistically significant differences in the VAS score （ P 〈 0. 05 ）. Radiography showed the fusion rate was 94%. There was no pedicle screw loosening, pull-out, breakage or cage displacement. Conclusions Single cage plus unilateral pedicle screw fixation for lumbar degenerative instability is reliable and provides satisfaction of lumbar fusion and clinical results.