单侧与双侧MIS-TLIF治疗中青年单节段腰椎间盘突出

Minimally invasive transforaminal lumbar internal fixation by unilateral versus bilateral pedicle screw in treatment of single level lumbar disc herniation in the young and mid-aged patients

目的：比较微创经椎间孔椎间融合术（ MIS-TLIF）单侧和双侧椎弓根螺钉固定治疗中青年单节段腰椎间盘突出症患者的临床疗效。方法对28例保守治疗无缓解的中青年单节段腰椎间盘突出症患者分别采用单侧或双侧MIS-TLIF治疗。对比两组手术时间、透视次数、术中出血量、术后引流量等指标,采用VAS评分、ODI、JOA评分改善率以及融合率评价手术效果。结果患者均获得随访,时间15-27个月。手术时间、透视次数、术中出血及术后引流量单侧固定均少于双侧固定,差异有统计学意义（ P〈0．05）；术后卧床时间和住院时间两组比较差异无统计学意义（P〉0．05）。术后2周、3个月、末次随访时VAS评分、ODI两组均较术前明显改善（P〈0．05）,VAS评分、ODI、JOA评分改善率两组之间差异无统计学意义（P〉0．05）。术后3个月及末次随访时两组的融合率比较差异无统计学意义（ P〉0．05）。结论 MIS-TLIF单侧椎弓根钉内固定联合椎间融合术治疗单节段腰椎间盘突出症安全有效,相比于双侧固定具有一定的优势。

Objective To compare the clinical effect of minimally invasive transforaminal lumbar internal fixation （ MIS-TLIF） by unilateral versus bilateral pedicle screw in treatment of single level lumbar disc herniation in the young and mid-aged patients. Methods The data of 28 patients with single level lumbar intervertebral disc herniation failed to conservative treatment,who received unilateral or bilateral fixation combined with MIS-TLIF were retrospec-tively analyzed. These data were compared including two groups of operation time, fluoroscopic times, intraoperative bleeding, postoperative drainage volume and other indicators. VAS, ODI, JOA scores improvement rate and fusion rate were used to evaluate the surgical effect. Results The patients were followed up for 15~27 months. Compared with the bilateral fixation, there were less operation time, fluoroscopic times,intraoperative bleeding and postoperative drainage volume in unilateral fixation, the diffence was significant（P〈0. 05）. There were no significant difference in the time of bed and hospital stays（P〉0. 05）. Compared with the preoperative,the VAS, ODI improved obviously at 2 weeks and 3 months postoperation, and last follow-up（P〈0. 05）,and there was no significant difference in VAS, ODI, JOA scores improvement rate between two groups（P〉0. 05）. There was no significant difference in fusion rate at 3 months and last follow-up between two groups（P〉0. 05）. Conclusions The unilateral pedicle screw fixation af-ter MIS-TLIF is safe and effective,which has clinical advantages in unilateral fixation,compared with bilateral fixa-tion.