单侧与双侧椎弓根螺钉固定、后路椎间融合术治疗腰椎间盘突出伴腰椎不稳症的临床研究

Clinical study of unilateral and bilateral pedicle screw fixation and posterior interbody fusion for the treatment lumbar disc hernia associated with lumbar instability

目的观察单侧和双侧椎弓根螺钉固定、后路椎间融合术治疗腰椎间盘突出伴腰椎不稳症的临床疗效。方法 52例单节段腰椎间盘突出伴腰椎不稳症患者分为两组,27例采用单侧椎弓根钉固定、椎间入Cage融合术治疗(A组);25例采用双侧椎弓根内固定、椎间Cage融合术治疗(B组)。术前、术后分别采用日本矫形外科学会(JOA)腰痛评分(15分法)评定神经功能,分别计算两组患者病情改善率和优良率,并随访观察植骨Cage融合情况和与Cage相关的并发症发生情况,比较两组术式的术中出血量、手术时间及骨性融合情况、相关并发症。结果术前,两组JOA评分比较差异无统计学意义(P>0.05),术后随访12～24个月,平均约16个月,术后末次JOA评分两组间比较差异有统计学意义(P<0.05),两组内术前与术后JOA评分比较差异有统计学意义(P<0.05)。A组中,手术时间平均130 min,术中出血量平均约270 mL;B组中,手术时间平均185 min,术中出血量平均约510 mL。经对比分析,两组术中出血量和手术时间差异均有统计学意义(P<0.05)。A组改善率平均为93.5%,B组为81.32%;A组优良率为96.54%,B组为82.14%;A、B组植骨融合率分别为92.6%、96%;两组术后相关并发症发生率分别为7.4%、4.0%。两组间改善率、优良率比较差异有统计学意义(P<0.05),两组间植骨融合率、术后相关并发症发生率比较差异均无统计学意义(P>0.05)。结论单侧椎弓根螺钉固定、后路椎间植骨治疗腰椎间盘突出伴腰椎不稳症,减压融合有效、促进神经功能恢复,是有效的治疗方法之一。

Objective To observe the clinical efficacy of unilateral and bilateral pedicle screws and interbody fusion for treating lumbar disc herniation with lumbar instability. Methods 52 cases of single segmental lumbar disc patients associated with lumbar instability were divided into two groups, 27 patients were applied with unilateral pedicle screw fixation and intervertebral Cage fusion（group A）, 25 patients were applied with bilateral pedicle screw fixation and in- tervertebral Cage fusion （group B）. The Japanese Orthopedic Association （JOA） score （15 points method） were respectively used for assessing nerve function preoperative and postoperative, and calculated the improvement rate and the excellent rate, the follow-up step was observed the interbody Cage fusion and cage-related complications, at the sometime also compared the surgical blood loss, surgical time and bony fusion-related complications. Results The JOA score of the two groups showed no significant difference （P 〉 0.05） before operation, after an average of 16 months fol- low-up （range, 12-24 months）, the difference of the final follow-up of JOA score was statistically significant between the two groups （P 〈 0.05） , and the difference of the JOA score was also statistically significant pre-operative and post-operation in the two groups （P 〈 0.05）. In group A, the mean operative time was 130 min, the mean blood loss was about 270 mL; In group B, the mean operative time was 185 min, the mean blood loss was about 510 mL. By comparison analysis, the blood loss and operative time differences were statistically significant in the two groups （P 〈 0.05）. The average improvement rate was 93.5% in group A and 81.32% in group B; the excellent rate was 96.54% in group A and 82.14%in group B, the postoperative complication rate was 7.4% and 4.0% in group A and group B, respectively. The difference of improvement rate and excellent rate was statistically significant in the two groups （P 〈 0.05） , the difference of fusion rate and the postoperative complications was not statistically significant （P 〉 0.05）. Conclusion The operation of unilateral pedicle screws and interbody fusion is one of the effective methods for treating lumbar disc herniation with lumbar instability, it is beneficial to decompression and fusion, and to promote the recovery of neurological function.