单侧椎弓根螺钉固定并椎体间植骨融合治疗腰椎退行性疾病的中期疗效评价

Mid-term outcomes of unilateral pedicle screw fixation with lumbar interbody fusion for lumber degenerative diseases

目的 评价单侧椎弓根螺钉固定并椎体间植骨融合治疗腰椎退行性疾病的中期临床疗效.方法 2008年10月至2010年12月东南大学附属江阴人民医院骨关节中心采用单侧椎弓根螺钉固定并椎体间植骨融合治疗42例腰椎退行性疾病患者,其中男18例,女24例;年龄平均52（38 ～69）岁.均为单节段手术,其中L3-42例,L4-5 19例,L5-S1 21例.观察手术时间、术中出血量及切口愈合情况,分析相关并发症.采用Oswestry功能障碍指数评分（ODI）和日本骨科学会评分（JOA）评价疗效,并且通过影像学检查对椎间隙不同部位高度、术后椎体间融合情况以及手术临近节段退变情况进行评价.结果 手术平均时间90 min,出血量约150 ml,手术切口均一期愈合.平均随访时间40（36～58）个月,ODI分值由术前的（59.1±9.6）分下降到末次随访时（8.5±2.7）分（P＜0.05）,JOA评分由术前（8.3±2.7）分提高到末次随访时（23.3±2.1）分（P＜0.05）,最终疗效评价优良者占88.1％,椎间隙腹侧、背侧高度均有明显提高,末次随访总融合率95.2％,相邻节段影像学观察退变发生率为9.5％.未发现继发性脊柱侧弯,螺钉松动、断裂等情况.结论 单侧椎弓根螺钉固定并椎体间植骨融合治疗腰椎退行性疾病,手术创伤小,经济方便,疗效显著.

Objective To evaluate the mid-term clinical outcomes of unilateral pedicle screw fixation with lumbar interbody fusion for lumber degenerative diseases.Methods From October 2008 to December 2010,unilateral pedicle screw fixation with lumbar interbody fusion was performed for a consecutive cohort of 42 patients.There were 18 males and 24 females with an average age of 52 （38-69） years.The operation level at L3-4 （n =2）,L4-5 （n =19）,L5-S1 （n =21） and multilevel （n =0）.Their clinical outcomes were assessed by Oswestry （ODI） scores and Japanese Orthopedics Association （JOA） questionnaires before and after operation.Operative duration,intraoperative blood loss,incision status and complications were recorded.Radiological examination was performed to assess the height of intervertebral space,the postoperative intervertebrai fusion conditions and the degeneration of adjacent segments.Results The mean operative duration was 90 minutes and mean blood loss 150 ml.All incisions healed primarily.The mean follow-up period was 40 （36-58） months.The ODI scores decreased significantly from 59.1 ± 9.6 preoperatively to 8.5 ± 2.7 postoperatively （P 〈 0.05）.The JOA scores improved markedly from 8.3 ± 2.7 preoperatively to 23.3 ± 2.1 postoperatively （P 〈 0.05）.And the proportion of optimal outcomes was 88.1%.The ventral and dorsal heights of intervertebal disc were significantly higher than those before operation.The fusion rate was 95.2% and the incidence of adjacent segment degeneration 9.5%.There was no occurrence of such complications as secondary scoliosis,screw loosening,internal fixation failure and cage slippage.Conclusion Unilateral pedicle screw fixation with lumbar interbody fusion is efficacious for lumber degenerative diseases with little surgical trauma.