单侧钉棒固定联合单枚Cage椎间融合治疗极外侧型腰椎间盘突出症的近期疗效

Short-Term Effect of Unilateral Pedicle Screw Fixation Combined with Single Cage Interbody Fusion on Extreme Lateral Lumbar Disc Herniation

目的：探讨单侧钉棒系统固定联合单枚 Cage 椎间融合术治疗极外侧型腰椎间盘突出症患者的近期临床疗效。方法对25例极外侧型腰椎间盘突出症患者均采用经椎板间、关节突切除途径髓核摘除，单侧钉棒系统结合单枚 Cage 椎间融合术治疗。采用视觉模拟评分（VAS）于术前、出院时及术后12个月随访时对患者下肢根性疼痛情况进行评分；采用 Schulte 标准判断植骨融合情况及 NaKai 标准评价患者术后12个月的临床疗效。结果25例患者手术顺利，手术时间为80～120（89．4±11．0）min，术中出血量为90～350（151．6±60．3）mL，术后无神经根损伤、脑脊液漏、椎间隙感染、切口感染等并发症发生。25例患者均获12～33（21．4±6．9）个月的随访，所有患者下肢根性疼痛症状术后均得到明显缓解。患者入院时 VAS 评分为（7．76±0．93）分，出院时、术后12个月 VAS 评分分别为（2．84±1．14）分、（1．48±1．23）分，出院时、术后12个月的 VAS 评分均明显低于术前（t＝21．36、22．92，均P ＜0．01）。术后12个月随访时，所有患者椎间植骨均融合，无内固定松动断裂，Cage 无移位、下沉；按 NaKai 标准：优15例，良7例，可3例，优良率为88．0％。结论单侧钉棒系统结合单枚 Cage 椎间融合术治疗极外侧型腰椎间盘突出症近期疗效满意，是一种可供选择的手术治疗方法。

Objective To investigate the short-term effect of unilateral pedicle screw fixation combined with single Cage interbody fusion on extreme lateral lumbar disc herniation.Methods Twenty-five patients with extreme lateral lumbar disc herniation were treated with facetectomy approach discectomy,unilateral pedicle screw fixation and single Cage interbody fusion.Radicular lower extremity pain was scored using the visual analogue scale（VAS）before discharge,at dis-charge and 12 months after operation.Bone graft fusion was judged using the Schulte standard. Clinical efficacy was evaluated using the NaKai standard 12 months after operation.Results The operation was successfully performed in all patients.The operation time was（89.4± 11.0）mi-nutes（range,80 to 120 minutes）.The intraoperatve blood loss was（151.6±60.3）mL（range,90 to 350 mL）.No nerve root injury,cerebrospinal fluid leakage,intervertebral space infection,inci-sion infection and other complications occurred in all patients after operation.After followed-up for（21.4±6.9）months（range,12 to 33 months）,radicular pain was obviously relieved in all pa-tients.The VAS scores at discharge（2.84± 1.14）and 12 months after operation（1.48± 1.23） were significantly lower than those before operation（7.76 ±0.93）（t =21.36 and 22.92,respec-tively;P 〈0.01）.After followed-up for 12 months,all patients had bone graft fusion without in-ternal fixation loosening and fracture and Cage shift and sinking.According to the NaKai stand-ard,clinical efficacy was excellent in 15 patients,good in 7 patients and fair in 3 patients.The ex-cellent and good rate was 88.0%.Conclusion The short-term effect of unilateral pedicle screw fixation combined with single Cage interbody fusion is satisfactory for the treatment of extreme lateral lumbar disc herniation.This method provides an alternative treatment for extreme lateral lumbar disc herniation.