椎间融合器联合椎弓根螺钉内固定治疗腰椎滑脱症合并腰椎间盘突出症

Intervertebral Fusion and Pedicle Screw Fixation for Spondylolisthesis with Lumbar Disc Herniation

目的:探讨椎间融合器联合椎弓根螺钉内固定治疗腰椎滑脱症合并腰椎间盘突出的早期临床疗效。方法:将2014年12月至2015年12月收治的腰椎滑脱症合并腰椎间盘突出拟行腰椎后路手术的患者随机分为两组,切除椎间盘后分别采用椎间融合器联合椎弓根螺钉系统(观察组)和单纯椎间融合器植骨融合(对照组)进行固定。比较术后1年两组疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),日本骨科协会(JOA)腰椎评分改善率、健康量表SF-36总分及生理职能、活力、社会功能、精神健康评分的改善情况。结果:两组术前疼痛VAS评分、ODI评分、JOA腰椎评分比较,差异均无统计学意义(P>0.05)。术后1年观察组患者的疼痛VAS评分(2.3±1.1)分、ODI评分(9.4±2.6)分,均低于对照组的(3.2±1.2)分和(11.2±2.7)分,差异具有统计学意义(P<0.05)。观察组术后半年JOA腰椎评分(22.0±2.8)分,高于对照组的(20.0±2.6)分,差异具有统计学意义(P<0.05)。观察组患者的总有效率96.7%(29/30)显著高于对照组73.3%(22/30),差异具有统计学意义(P<0.05)。结论:腰椎滑脱症合并腰椎间盘突出采用椎间融合器联合椎弓根螺钉内固定治疗可以获得较好的早期临床疗效,在疼痛症状缓解、腰椎功能改善及生活质量提高方面优于单纯椎间融合器植骨融合。

Objective To explore the clinical effects of pedicle screw combined with intervertebral fusion in the treatment of lumbar disc herniation with spondylolisthesis. Methods From December 2014 to December 2015, 60 patients with lumbar disc herniation with spondylolisthesis were divided into two groups treated lumbar posterior pedicle screw or intervertebral fusion cage fixation. were analyzed by VAS and ODI scores respectively. To assess the recovery of the clinical symptoms after the operation and physiological function, vitality, social function,mental health improvement, JOA score and SF-36 score was applied. Results The fusion time was 6 to 11 months（8.1 ± 1.3） months in the observation group. The time of fusion was 7 to 12 months（7.3 ± 0.8） months in the control group. The difference was not statistically significant（P 0.05）. There was no significant difference in VAS score, ODI score and JOA lumbar vertebra score between the two groups（P 0.05）. The scores of VAS（2.3 ± 1.1） and ODI（9.4 ± 2.6） were lower than those of the control group（3.2 ± 1.2） and（11.2 ± 2.7）, respectively. The difference was statistically significant（P 0.05）. The scores of JOA lumbar vertebrae（22.0 ± 2.8） in the observation group were higher than those in the control group（20.0 ± 2.6）, the difference was statistically significant（P 0.05）. The total effective rate was 96.7%（29/30） in the observation group and 73.3%（22/30） in the control group, the difference was statistically significant（P 0.05）. ConclusionThe posterior open reduction of intervertebral fusion and pedicle screw fixation for lumbar disc herniation with spondylolisthesis has affirmative curative effect. The improvement of clinical symptoms is obviously applied for clinical treatment.