单侧椎弓根螺钉固定联合TLIF行腰椎融合术的中期疗效

Unilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for degenerative lumbar diseases: a mid-term outcomes observation

[目的]比较单侧与双侧椎弓根螺钉固定联合经椎间孔椎间融合术(TLIF)治疗腰椎退行性疾病的中期临床疗效。[方法]回顾性分析2009年5月~2010年12月采用单侧或双侧椎弓根螺钉联合经椎间孔椎间融合术治疗59例腰椎退行性疾病患者,其中单侧固定27例,双侧固定32例,对两组患者的手术时间、出血量、住院时间和住院费用等进行比较,采用Oswestry功能障碍指数评分(ODI)评价疗效,通过影像学评估椎体间融合情况及邻近椎间盘退变情况。[结果]所有患者获5年以上随访。单侧组在手术时间、出血量等指标上优于双侧组(P<0.05)。术前,术后3、12个月ODI评分单侧固定与双侧固定差异无统计学意义(P>0.05),但术后5年ODI评分比较差异有统计学意义(P<0.05)。融合率单侧固定与双侧固定差异无统计学意义(P>0.05)。影像学检查相邻节段退变单侧固定较双侧固定发生率低(P<0.05)。[结论]单侧或双侧椎弓根螺钉联合经椎间孔椎间融合术治疗腰椎退行性疾病均能获得满意的疗效,单侧固定在降低邻椎病具有潜在优势。

[Objectives] To compare the mid-term outcomes of unilateral versus bilateral pediele screw fixation combined with transforaminal lumbar interbody fusion（TLIF） for treatment of degenerative lumbar diseases. [Methods] From May 2009 to December 2010,59 patients with the degenerative disorders of lumbar spine were treated with pedicle screw fixation and TLIF. Patients included 34 males and 25 females, with the average age of 50.9 years（range, 48-65 years）. According to the different surgical approaches, 27 patients were randomized to the unilateral group and 32 patients to the bilateral group.The general clinical data were compared between two groups, including operation time,blood loss volume and hospitalization time. Postoperative functional results were analyzed by Oswestry disability index（ODI）.Radiological examination was obtained for each patient to assess fusion outcome and degeneration grade of adjacent segment disc. [Results] The mean follow-up was over 5 years. Operation time and blood loss volume in unilateral group were less than that of bilateral group, with significant difference（P〈0.05）. Oswestry Disability Index scores showed no significant differences between the two groups preoperatively, at 3, 12 month postoperatively, but significant difference was noted at final follow-up（5 years postoperatively,P〈0.05）.The fusion rate showed no significant difference between two groups during the follow-up period（P〈0.05）. However, the degeneration grade of adjacent segment in unilateral group was less than that in bilateral group at final follow-up, indicating significant difference（P〈0.05）. No complications was found in both two groups, such as secondary scoliosis, cage slippage,screw loosening or internal fixation failure. [Conclusions] Having the similar clinical outcomes as bilateral pedicle screw fixation, unilateral pedicle screw fixation still has potential advantage in preventing adjacent segment disease.