单侧椎弓根螺钉对侧经关节突螺钉固定联合椎体间融合术与传统手术治疗腰椎管狭窄症效果和安全性比较

Unilateral pedicle screws on the side of the transarticular screw fixation combined with interbody fusion and traditional operation in the treatment of lumbar tube stenosis of the efficacy and safety of comparison

目的 探讨单侧椎弓根螺钉对侧经关节突螺钉固定联合椎体间融合术与传统手术治疗腰椎管狭窄症的治疗效果和安全性.方法 回顾性分析2012年2月至2015年4月在我科就诊的40例腰椎管狭窄症患者,随机分为两组,分别采用单侧椎弓根螺钉对侧经关节突螺钉固定（观察组20例）和双侧椎弓根螺钉固定（对照组20例）联合椎间融合术治疗,比较两组术中出血量、手术时间、切口长度和术后引流量;术后定期随访,观察融合效果,采用日本骨科协会（JOA）评分评价脊柱功能,并观察不良反应发生情况.结果 观察组术中出血量、手术时间和术后引流量分别为（321.60±12.35） ml、（101.18±4.11） min、（212.14±18.78） ml,均显著低于对照组的（377.24±18.11） ml、（134.49±5.25） min、（256.27±15.19） ml （t值分别为2.80、4.11、-3.88,P均〈0.05）,而切口长度分别为（6.46±0.14）、（6.49±0.13） cm,两组差异无统计学意义 （t=0.10,P〉0.05）;观察组术后3个月的融合率和JOA评分分别为（100±0）%、（87.5±2.4）分,与对照组（100±0）%、（86.3±2.2）分比较差异均无统计学意义（t值分别为0、0.20,P均〉0.05）;观察组术后1年的融合率和JOA评分分别为（100±0）%、（91.9±1.7）分,与对照组（100±0）%、（92.1±1.5）分比较差异无统计学意义（t值分别为0、0.35,P均〉0.05）;末次随访观察组椎间隙高度（8.25±0.13） mm,高于对照组的（6.97±0.16） mm,（t=3.90,P〈0.001）;对照组2例出现硬脊膜漏,3例出现神经损伤,发生率为25%,高于观察组（0）,组间差异有统计学意义（P=0.03）.结论 单侧椎弓根螺钉对侧经关节突螺钉固定联合椎体间融合术治疗腰椎管狭窄症手术创伤小,术后恢复快,近期脊柱稳定性好,值得临床推广.

Objective To investigate the contralateral transarticular screw fixation combined with interbody fusion and traditional operation in the treatment of lumbar tube stenosis of the efficacy and safety of unilateral pedicle screw.Methods A retrospective analysis was made in General Hospital of Lanzhou Petrochemical Company from February 2012 to April 2015.Forty cases of lumbar spinal stenosis patients were analyzed respectively,using unilateral pedicle screws on the side of transarticular screw fixation（observation group,20 cases） and bilateral pedicle screw fixation （control group,20 cases） and interbody fusion for the treatment.Between the two groups in the amount of bleeding,operation time,incision length,postoperative drainage were compared.Regular follow-up after operation,the fusion effect was observed,the JOA score was used to evaluate spinal function and observe adverse reaction incidence.Results Intraoperative bleeding volume,operation time and postoperative drainage in the observation group were （321.60±12.35） ml,（101.18±4.11） min,（212.14±18.78） ml,lower than that in control group（（377.24±18.11） ml,（134.49±5.25） min,（256.27±15.19） ml,t=2.80,4.11,-3.88,P〈0.05）.While the incision length was （6.46 ±0.14） cm,（6.49±0.13） cm,respectively and there was no significant difference between the two groups（t=0.10,P〉0.05）.The fusion rate and JOA score in the observation group after 3 months of observation group was （100±0）% and （87.5±2.4） points,there was no statistically significant difference compared with the control group（（100±0）% and （86.3±2.2） points,t=0,0.20,P〉0.05）.The fusion rate and JOA score in the observation group after 1 year was （100±0）% and （91.9±1.7） points,there was no statistically significant difference compared with the control group（（100±0）% and （92.1±1.5） points,t=0,0.35,P〉0.05）.The height of intervertebral space in the last follow-up group in the observation group was （8.25±0.13） mm,higher than that of the control group（（6.97±0.16） mm,t=3.90,P〈0.001）.In adverse reactions,the observation group did not appear to be related to complications,while 2 cases in the control group dural leakage,3 cases of nerve injury,rate was 25%（P=0.03）.Conclusion Unilateral pedicle screws on the side of the transarticular screw fixation combined with interbody fusion for the treatment of lumbar tube stenosis surgical trauma,postoperative recovery,spinal stability is good in the near future,it is worth clinical promotion.