经多裂肌间隙单侧椎弓根钉固定椎间融合治疗腰椎退行性疾病的疗效分析

Clinical outcome analysis of unilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus for lower lumbar degenrative diseases

目的探讨经多裂肌问隙单侧椎弓根钉固定单枚cage椎间融合治疗腰椎退行性疾病的疗效。方法自2009年4月～2011年6月经多裂肌间隙单侧椎弓根钉固定单枚cage椎间融合治疗63例此类患者，均为单节段固定，应用视觉模拟评分系统（VAS）评价患者术前、术后疼痛情况。应用Oswestry功能障碍指数评分（ODI）和日本骨科学评分（JOA）评价疗效．应用Schulte标准评价植骨融合情况。结果56例获得随访14～32个月，平均25．1个月。患者术前VAS评分（6．70±0．71）分，术后3个月VAS评分（1．61±0．59）分（P〈0．01）；ODI分值由术前（29．39±3．92）降至末次随访（3．54±2．21）（P〈0．01）；JOA评分由术前（8．04±1．22）分提高至末次随访（22．70±2．28）分（P〈0．01）；疗效评价优良者占83．9％，末次随访植骨融合率92．8％。结论经多裂肌间隙单侧椎弓根钉固定椎间融合是治疗腰椎退行性疾病的有效手术方式，具有手术时间短、创伤小、住院费用少、疗效显著等优点。

Objective To explore the clinical outcome of unilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalareof muhifidus for lower lumbar degenerative diseases. Methods From April 2009 to June 2011, 63 patients underwent unilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus and no case was at multilevel. Clinical outcomes were assessed by ODI scores ,VAS scores and JOA questionnaires before and after operation. Lumbar interbody fusion was evaluated by standard of Schulte. Results All of 56 cases were followed up for 14-32 months. The mean followed time was 25.1 months. The VAS was （6.70±0.71） before operation, （1.61± 0.59） at 3 months after operation, and there were statistically significant differences in the VAS score（P 〈0.01）. The ODI scores decreased significantly from （29.39±3.92） preoperatively to （3.54±2.21） at last follow-up （P 〈0.01）. The JOA scores were improved remarkably from （8.04±1.22） preoperatively to （22.70±2.28） pestoperatively（P 〈0.01） and the proportion with optimal effect was 83.9%. The fusion rate was 92.8% at last follow-up. Conclusion Through spatium intermuscalare of muhifidus with unilateral pedicle screw fixation plus single cage interbody fusion is an effective and convenient method with little surgical trauma and quick recovery.