单边和双边椎弓根钉棒内固定联合椎间融合术治疗腰椎间盘突出症疗效比较

Comparison of clinical efficacy between unilateral and bilateral pedicle screw fixation combined with interbody fusion for lumbar disc herniation

目的比较单边和双边椎弓根钉棒内固定联合椎间融合术治疗腰椎间盘突出症的临床疗效。方法将28例腰椎间盘突出症患者按手术方法分为两组:观察组(14例)采用单边椎弓根钉棒内固定联合椎间融合术治疗;对照组(14例)采用双边椎弓根钉棒内固定联合椎间融合术治疗。比较两组的住院费用、术中出血量、手术时间和术后下地时间;定期采用JOA评分评价脊柱功能,复查X线片判断融合效果;复查MRI明确上下邻近节段椎体高度。结果观察组住院费用、术中出血量、手术时间低于对照组,术后下地活动时间长于对照组,差异均有统计学意义(P<0.05);术后3个月和1年融合率和JOA评分两组差异均无统计学意义(P>0.05);末次随访腰椎前凸角、矢状面平衡和颌眉角观察组高于对照组,差异均有统计学意义(P<0.05);胸椎后凸角两组差异无统计学意义(P>0.05)。观察组上、下邻近节段椎体高度明显高于对照组,差异有统计学意义(P<0.05)。结论单边椎弓根钉棒内固定联合椎间融合术治疗腰椎间盘突出症可获得较好的近期脊柱稳定性。

Objective To compare the clinical efficacy of unilateral and bilateral pedicle screw fixation combined with interbody fusion in the treatment of lumbar disc herniation. Methods According to different surgical methods, 28 cases of lumbar disc herniation patients were divided into two groups. Observation group（14 cases） was applied with unilateral pedicle screw rod internal fixation combined with interbody fusion,and the control group（14 cases） was treated with bilateral pedicle screw rod internal fixation combined with interbody fusion. The hospitalization expenses, intraoperative bleeding volume, operation time and postoperative ambulation time were compared between two groups;JOA score was used to evaluate the spinal function, X-ray film was reexamined to evaluate the fusion effects; MRI was reexamined to calculate the height of adjacent vertebral bodies. Results For the observation group, the hospital-ization expenses, intraoperative bleeding volume, operation time were lower than those of the control group, and the postoperative ambulation time was slightly longer than that of the control group, the differences were statistically sig-nificant （P〈0. 05）; the fusion rate and the JOA score at postoperative 3 months and 1 year between two groups showed no statistical significance （P〉0. 05）;the final follow-up of lumbar lordosis, sagittal balance and chin brow vertical angle for observation group were slightly higher than those of the control group, and the differences were sta-tistically significant （P〈0. 05）;and the posterior convex angle of thoracic vertebrae between the two groups showed no statistical difference（P〉0. 05）. The height of upper and lower adjacent segment vertebral body of the observation group were significantly higher than those of the control group, and the difference was statistically significant （ P〈0. 05）. Conclusions Unilateral pedicle screw fixation combined with interbody fusion in treatment of lumbar disc herniation can obtain a better short-term stability of spine.