摘要
目的:比较MIS-TLIF单侧和双侧椎弓根螺钉固定治疗腰椎间盘突出症的临床效果。方法46例腰椎间盘突出症患者分别采用MIS-TLIF单侧椎弓根螺钉固定(单侧固定组,18例)和双侧椎弓根螺钉固定(双侧固定组,28例),采用VAS评分及ODI评分评估手术疗效。结果手术时间:单侧固定组为90~160(115±14.5) min,双侧固定组130~220(160±17.2) min,差异有统计学意义(P〈0.05)。术中出血量:单侧固定组为210~450(300±41.8) ml,双侧固定组为300~600(420±56.3)ml,差异有统计学意义(P〈0.05)。患者均获得随访,单侧固定组随访15~31(25.2 ±5.1)个月,双侧固定组随访16~34(26.4±5.6)个月。 VAS评分:单侧固定组术前为6.0分±1.2分,术后为2.1分±1.1分,术后1年为2.0分±1.2分;双侧固定组术前为5.9分±1.6分,术后为2.0分±0.8分,术后1年2.1分±0.7分。 ODI评分:单侧固定组术前为43.0分±1.9分,术后为15.0分±2.8分,术后1年14.0分±1.9分;双侧固定组术前为42.0分±2.1分,术后为13.0分±1.9分,术后1年12.0分±1.8分。两组两项评分术后与术前比较差异均有统计学意义(P〈0.05),组间比较差异均无统计学意义(P〉0.05)。两组均椎间植骨融合良好,无内固定松动、断裂及融合器移位等情况。结论 MIS-TLIF单侧椎弓根螺钉固定加单枚cage植入术治疗腰椎间盘突出症可以获得与双侧固定相同的临床疗效,且具有手术时间短、术中出血量少、组织损伤轻等优点。
Objective To compare the clinical outcomes of unilateral and bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion ( MIS-TLIF) for the treatment of lumbar disc herniation. Methods 46 patients with lumbar disc herniation were divided into two groups randomly, 18 cases of which were received oper-ation of unilateral pedicle screw fixation combined with single cage implantation of MIS-TLIF and other 28 cases were received operation of traditional bilateral fixation. Clinical outcomes were determined by using VAS score and ODI score criterion. Results The operation time in unilateral group was 90~160(115 ± 14. 5) min, bilateral group was 130~220(160 ± 17. 2) min. Difference between the two groups was statistically significant (P〈0. 05). The blood loss in unilateral group was 210~450(300 ±41.8)ml, bilateral group was 300~600(420 ±56.3)ml. Difference was statistically significance between the two groups(P〈0. 05). All patients were followed up for 15~31(25. 2 ± 5. 1)months in unilateral group, while 16~34(26. 4 ± 5. 6)months in bilateral group. The VAS score of the unilater-al group was 6. 0 ± 1. 2 before operation, and 2. 1 ± 1. 1 after operation,1-year follow-up was 2. 0 ± 1. 2. The bilateral group VAS score was 5. 9 ± 1. 6 before operation and 2. 0 ± 0. 8 after the surgery, 1-year follow-up was 12. 1 ± 0. 7. The ODI score of unilateral group was 43. 0 ± 1. 9 before operation, and 15. 0 ± 2. 8 after operation,1-year follow-up was 14. 0 ± 1. 9. The bilateral group ODI score was 42. 0 ± 2. 1 before surgery and 13. 0 ± 1. 9 after operation, 1-year follow-up was 12. 0 ± 1. 8. There were significant difference for the VAS score and ODI score postoperation compared with preoperation in each groups (P〈0. 05), there was no statistically significant difference between the two groups (P〉0. 05). There were no complications related to internal fixation breakage, loosening or cage displacement. Con-clusions Operation of unilateral pedicle screw fixation combined with single cage implantation of MIS-TLIF for the treatment of lumbar disc herniation has similar clinical outcome compared with traditional bilateral fixation way, which can minimize blood loss and tissue trauma, shorten the operative time.
出处
《临床骨科杂志》
2015年第5期548-551,共4页
Journal of Clinical Orthopaedics
关键词
外科手术
微创性
腰椎间盘突出症
内固定
surgical procedures,minimally invasive
lumbar disc herniation
internal fixation