单侧椎弓根钉联合对侧关节突螺钉内固定治疗下腰椎退行性疾病

Clinical application of unilateral pedicle screw combined with contralateral translaminar facet screw fixation in the treatment of low lumbar degenerative diseases

目的探讨单侧椎弓根钉结合对侧椎板关节突螺钉固定在治疗下腰椎退行性疾病中的临床价值。方法回顾我院2011-06-2012-06年间收治的60例下腰椎退行性疾病患者,随机分为2组。30例观察组患者在微创系统下以椎弓根钉联合对侧的椎板关节突螺钉固定术对患者进行治疗;30例对照组患者以后路双侧弓根螺钉内固定术进行治疗。以Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)对两组的疗效进行对比;并对两组患者切口大小、手术用时、出血量、引流量、住院天数以及椎体稳定性、再手术率进行对比分析。结果术后1周,观察组患者VAS得分显著性高于对照组,P<0.05,术后3、6个月,两组患者VAS和ODI评分无显著性差异,P>0.05;观察组患者的切口大小、手术用时、出血量、引流量、住院天数等都显著性少于对照组患者,P<0.05;两组患者的融合率比较无显著性差异;观察组患者椎体稳定性高于对照组,P>0.05;观察组患者椎体再手术率低于对照组,P>0.05。结论单侧椎弓根钉联合对侧椎板关节突螺钉内固定术临床操作简单、创部出血量少、稳定可靠、疗效确切,值得推广。

Objective To investigate the surgical outcome of unilateral pedicle screw com- bined with contralateral translaminar facet screw fixation vs bilateral pedicles screws fixation after posterior decompression and intervertebral cage fusion for lower lumbar degenerative diseases. Methods 60 cases with single level lumbar disc disease in our hospital from June 2011 to June 2012 were retrospectively analyzed. Patients were randomly divided into two groups,30 cas- es in each group. 30 cases in observation group underwent MIS decompression and transforami- nal lumbar interbody fusion（TLIF）,unilateral pedicle screw combined with contralateral translami- nat facet screw under Mast Quadrant. 30 cases in control group underwent traditional open de- compression and posterior lumbar interbody fusion（PLIF）. After surgery,the skin incision length, operative time,blood loss,postoperative draining,hospital stay and complications were analyzed retrospectively. Index（ODI） and back and leg pain Visual Analogue Scores（VAS） were used for clinical assessment. Results The VAS score of back pain at postoperative 1 week in observa- tion group was higher than that of control group （P〈0.05）. There was no significant difference between two groups with respect to VAS and ODI scores at other time points. The length of in- cision,operative time,blood loss,postoperative draining and hospital stay of observation group were significantly lower than those of control group （P〈0.05）. The vertebral stability of obser-ration group was higher than that of control group （P〉0.05）. The vertebral reoperation rate of ob- servation group was lower than that of the control group （P〉0.05）. Conclusion Unilateral pedicle screw combined with contralateral translaminar facet screw in transforaminal lumbar interbody fusion under Mast Quadrant has some advantages of easy-handling,minimal invasive and reliable curative effect,and is more in accordance with the principles of minimally invasive.