单侧与双侧后路椎体间融合术治疗腰椎间盘突出伴腰椎不稳的疗效比较

Comparative study of the modified unilateral posterior lumbar interbody fusion with bilateral posterior lumbar interbody fusion for lumbar disc herniation with lumbar instability

目的：比较单侧和双侧后路椎体间融合术（ PLIF）治疗腰椎间盘突出伴腰椎不稳的临床疗效。方法手术治疗51例腰椎间盘突出伴腰椎不稳患者，其中行单侧PLIF治疗26例（单侧组），行双侧PLIF治疗25例（双侧组），比较两组的手术时间、术后并发症、临床疗效满意率和植骨融合率。结果手术时间：双侧组（168±20） min，单侧组（94±18） min；术中出血量：双侧组（750±41） ml，单侧组（450±40） ml；术后输血：双侧组7例，单侧组均未输血；以上各项两组比较差异均有统计学意义（ P＜0.05）。术中硬膜囊撕裂：双侧组1例，单侧组无。术后神经根痛加剧：双侧组2例，单侧组1例。患者均获得随访，时间14～30个月。临床疗效优良率：双侧组为84.0％（21／25），单侧组为92.3％（24／26），差异有统计学意义（P＜0.05）。植骨融合率：双侧组为92.0％，单侧组为96.1％，差异无统计学意义（P＞0.05）。结论单侧PLIF治疗腰椎间盘突出伴腰椎不稳创伤小，并发症少，临床疗效满意率优于双侧PLIF。

Objective To investigate the clinical outcome of the unilateral posterior lumbar interbody fusion （ PLIF） with bilateral PLIF for lumbar disc herniation with lumbar instability .Methods 51 patients with different type of lumbar disc herniation with lumbar instability were treated by the modified unilateral PLIF （ 26 cases ） and bilateral PLIF（25 cases）.An observational study of operational duration , volume of bleeding, the therapeutic effect, rate of bone graft fusion was conducted .Results The operational duration was （168 ±20） minutes in bilateral PLIF group and （94 ±18） minutes in unilateral PLIF group .The volume of bleeding was （750 ±41） ml in bilateral PLIF group and （450 ±40） ml in unilateral PLIF group.Postoperative blood transfusion： there were 7 cases in bilateral group, but no case needed blood transfusion in the unilateral group;the above difference between the two groups was statisti-cally significant （ P〈0.05 ） .Intraoperative dural tear：1 case was in bilateral group , no case in unilateral group . Nerve root pain increased after surgery：2 cases in bilateral PLIF group and 1 case in unilateral PLIF group .All pa-tients were followed up for 14~30 months.The excellent-good rate of clinical efficacy was 84.0%（21/25）in bilater-al PLIF group and 92.3%（24/26） in unilateral PLIF group,the diffence was statistically significant （P〈0.05）. The rate of bone graft fusion was 92.0%in bilateral PLIF group and 96.1% in unilateral PLIF group （ P〉0.05 ） . Conclusions The unilateral PLIF is safe and efficient techniques to treat lumbar disc herniation with lumbar instabil -ity.There is no significant difference in rate of graft fusion , but unilateral PLIF is superior to bilateral PLIF in the as-pects of clinical efficacy, operational time, trauma, complications and so on.