单侧腰椎椎弓根螺钉固定结合椎间融合治疗腰椎退变性疾病

Unilateral lumbar pedicle screw fixation combined with interbody fusion in the treatment of lumbar degenerative disease

目的 探讨单边固定椎体间融合治疗腰椎退变性疾病的临床疗效.方法 2009年1月至2012年1月对17例L4~5椎间盘突出伴腰椎不稳患者行单侧椎弓根螺钉内固定根管减压椎间Cage融合术（A组）,17例L4~5椎间盘突出伴腰椎不稳者行双侧椎弓根螺钉固定椎板切除减压椎间Cage融合术（B组）.观察两组的手术时间、术中出血量、住院时间,术前、术后拍摄X线测量腰椎间隙高度的变化,融合节段融合率的变化,按日本外科矫形学会（JOA）的下腰痛评分标准评价临床疗效.结果 术后所有患者下腰部疼痛、下肢根性疼痛症状得到缓解,手术时间、术中出血量、住院时间两组相比有统计学意义（P＜0.01）;术后18个月随访时两组椎间隙高度、植骨融合率比较无统计学意义（P＞0.05）;术后1个月两组JOA评分比较无统计学意义（P＞0.05）,术后18个月两组JOA评分比较有统计学意义（P＜0.05）.结论 相对于双侧椎弓根螺钉固定椎板减压椎间Cage融合术,采用单侧椎弓根螺钉固定根管减压椎间Cage融合术治疗L4~5椎间盘突出伴腰椎不稳疗效明显、费用降低、创伤小、愈合快,是治疗L4~5椎间盘突出伴腰椎不稳的可靠方法.

Objective To investigate the clinical curative effect of unilateral lumbar pedicle screw fixation combined with interbody fusion in the treatment of lumbar degenerative disease.Methods From January,2009 to January,2012, 17 patients（Group A） with herniated disc（L4-5 ）and lumbar instability underwent unilateral lumbar pedicle screw fixa- tion combined with interbody fusion.Another 17 patients（Group B） with the same symptoms underwent bilateral lumbar pedicle screw fixation combined with lamina resection decompression intervertebral Cage fusion.The duration of operation,intraoperative blood loss and length of hospital stay of both groups were observed.Radiography was carried out to measure the changing height of lumbar disc and the fusion rate before and after the operation. Besides, clinical results were evaluated according to JOA＇ s （Japanese Orthopaedic Association） scoring criteria of lower back pain.Resuits After surgery,the low back pain and radicular pain of lower limbs of all patients were alleviated. There was significant difference in the comparion of duration of operation, intraoperative blood loss and length of hospital stay between two groups（ P 〈0.01）.No significant difference was found in the comparison of height of lumbar disc and the fusion rate between two groups at the 18th month follow-up visit after surgery（ P 〉0.05）.In one month after operation,the difference in JOA scoring between two groups was not statistically significant （ P 〉 0.05）, while 18 months later two groups＇ scores were significantly different（ P 〈0.05）.Conclusion Comparing with bilateral lumbar pedicle screw fixation combined with lamina resection decompression intervertebral Cage fusion, unilateral lumbar pedicle screw fixation combined with lamina resection decompression intervertebral Cage fusion for treating herniated disc（L4-5 ） and lumbar instability has the advantages of reliable curative effect,lower medical costs, less trauma, rapid wound healing. It is a satisfactory treatment to cure herniated disc（L4-5 ）with lumbar instability.