椎板扩大开窗减压椎间融合单侧固定在腰椎退行疾病中的应用

Posterior expanded laminectomy decompression and interbody unilateral pedicle screw fixation in the lumbar spine degenerative diseases

目的探讨后路椎板扩大开窗减压椎间植骨单侧椎弓根螺钉固定在腰椎退行疾病手术中的临床疗效。方法对92例腰椎退行性疾病患者分别采用后路椎板扩大开窗减压椎间植骨单侧椎弓根螺钉固定(A组,40例)和后路椎板扩大开窗减压椎间植骨双侧椎弓根螺钉固定(B组,52例)。比较两组JOA评分、VAS评分、手术时间、术中出血量、住院时间、住院费用、植骨融合率、椎间隙高度及并发症情况。结果患者均获得12个月随访。JOA评分优良率:A组为97.5%,B组为96.2%;VAS评分:A组为1.5分±1.0分,B组为1.4分±0.5分;椎间隙高度:A组为(12.6±1.0)mm,B组为(12.2±0.7)mm。两组上述3项指标比较差异均无统计学意义(P>0.05)。手术时间:A组为(85.2±17.9)min,B组为(115.6±25.3)min;术中出血量:A组为(250.6±50.2)ml,B组为(455.1±150.2)ml;住院时间:A组为(10.5±1.6)d,B组为(14.2±2.1)d;住院费用:A组为(18 251±453.2)元,B组为(24 583±673.1)元。两组上述4项指标比较差异均有统计学意义(P<0.01)。植骨融合率:A组为95%,B组为94%,差异无统计学意义(P=0.69)。结论改良腰椎后路椎间植骨单侧椎弓根螺钉固定是一种切实有效的腰椎融合术式,与传统术式相比具有创伤小、风险小和医疗费用少的优点,但远期疗效仍需进一步随访与研究。

Objective To investigate the clinical efficacy of posterior lamina fenestration expanding interbody unilater-al pedicle screw fixation in degenerative disease of the lumbar spine. Methods 92 cases underwent posterior lumbar fusion surgery were retrospectively studied. Unilateral pedicle screw group （ group A, 40 patients） , bilateral pedicle screw fixation （ group B, 52 patients） . JOA score, VAS score, operative time, blood loss, hospitalization time,hos-pitalization expenses,bone graft and fusion rates,intervertebral height,complication rates were analyzed. Results All patients were followed up for 12 months. The excellent and good rate of postoperative JOA scores in group A was 97. 5%, group B was 96. 2%;VAS score：group A （1. 5 ± 1. 0） points, group B （1. 4 ± 0. 5） points;Intervertebral height：group A 12. 6mm ± 1. 0mm, group B 12. 2mm ± 0. 7mm. These three indicators of the two groups had no sta-tistical significance （P〉0. 05）. Operative time： group A 85. 2 min ± 17. 9min, group B 115. 6 mm ± 25. 3min. Blood loss：group A 250. 6 ml ± 50. 2ml, group B 455. 1 ml ± 150. 2ml. Hospitalization time：group A （10. 5 ± 1. 6） d ,group B （14. 2 ± 2. 1） d. Hospitalization expenses：group A （18 251 ± 453. 2） yuan, group B （24 583 ± 673. 1） yuan. These four indicators of the two groups were statistically significant （P〈0. 01）. Successful bone graft and fu-sion rate：group A was 95%, group B was 94%, there was no statistically significant difference （P=0. 69）. Con-clusions The modified posterior lumbar interbody unilateral pedicle screw fixation can achieve satisfactory clinical efficacy, compared with the traditional operation with less trauma, less risky and medical expenses of advantages, but long-term efficacy need further follow-up and research.