微创经椎间孔腰椎椎间融合术单侧与双侧椎弓根螺钉内固定临床对照研究

Clinical comparative analysis of minimally invasive transforaminal lumbar interbody fusion with unilateral and bilateral pedicle screw fixation

目的比较微创经椎间孔腰椎椎问融合术（MIS-TLIF）联合单侧椎弓根螺钉（uPs）内固定与双侧椎弓根螺钉（BPS）内固定治疗单节段腰椎退行性疾病临床疗效、影像学检查结果及手术费用。方法2010年8月至2013年10月，采用MIS-TLIF联合椎弓根螺钉内固定治疗42例单节段腰椎退行性疾病患者。根据后侧内固定方式，将42例患者分为UPS组（20例）和BPS组（22例）。比较两组患者手术前后疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评分、手术时间、术中出血量、术后下地时间、并发症发生率、腰椎椎间融合率、手术费用等。结果UPS组平均随访（26．9±5．9）个月（17439个月），BPS组平均随访（34．6±11．2）个月（12446个月），两组患者术后vAS、0DI评分较术前均有明显改善（P〈O．05），但两组组间无显著性差异（P〉0．05）。UPS组手术时间、术中出血量、术后下地时间分别为（151．3±25．5）min、（117．5±61．3）ml、（3．6±1．5）d，BI唱组分别为（181．6±35．8）min、（209．1±157．8）ml、（6．4±4．3）d，两组组间有显著性差异（P〈O．05），UPS组明显优于BPS组。两组术中及术后并发症发生率、腰椎椎间融合率无显著性差异（P〉O．05）。UPS组手术费用为（36359．0±4081．4）元，BPS组为（57058．4±7169．1）元，UPS组优于BPS组，差异有统计学意义（P〈0．05）。结论M1S-TLIF联合UPS内固定治疗单节段腰椎退行性疾病可取得与MIS-TLIF联合BPS内固定相当的临床疗效和影像学检查结果，且在手术时间、术中出血量、术后下地时间、手术费用等方面更具优势。

Objective To compare the clinical, radiographic outcomes and surgical costs between unilateral and bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） for single-level lumbar degenerative disease. Methods From Auguest 2010 to October 2013, total 42 patients with single-level lumbar degenerative disease were treated of MIS-TLIK According to the different fixation, they were divided into unilateral pedicle screw （UPS） group which had 20 cases and bilateral pedicle screw （BPS） group which had 22 cases. The preoperative and postoperative visual analogue scale （VAS） and Oswestry disability index （ODD scores, operation time, intraoperative blood loss, postoperative ambulation time, complication rate and fusion rate were observed and compared between two groups. The surgical costs were also compared. Results The mean follow-up time was 26.9 ±5.9 months （ranged, 17-39 months） in UPS group and 34. 6 ± 11.2 months （ranged, 12-46 months） in BPS group. The postoperative VAS and ODI scores of two groups were better than the preoperative outcomes （P〈0. 05）, but there was no statistical deference between two groups （P）0. 05）. Operation time, intraoperative blood loss, postoperative ambulation time were 151.3 ± 25.5 rain, 117. 5 ± 61.3 ml, 3. 6 ± 1.5 d in UPS group respectively, and they were 181.6 ±35.8 min, 209. 1 ± 157.8 ml, 6. 4 ±4. 3 d in BPS group respectively. These parameters of UPS group were superior to which of BPS group, there were significant differences between two groups （P〈0. 05）. There were no statistically significant differences in intraoperative and postoperative complication rates, fusion rates （P〉0. 05）. The surgical costs in LIPS group （￥36359. ±0 4081.4） were significantly less than them in BPS group ￥57058. 4±7169. 1） （P〈0. 05）. Conclusions MIS-TLIF with UPS and BPS fixation have comparable good clinical and radiographic outcomes for single-level lumbar degenerative disease. Moreover, UPS fixation has more advantages on operation time, intraoperative blood loss, postoperative ambulation time and surgical costs.