单侧经皮关节突椎弓根螺钉联合对侧钉棒固定与双侧钉棒固定治疗腰椎退行性疾病的比较

Clinical efficacy of unilateral percutaneous transfacet screws combined with contralateral pedicle screw versus bilateral pedicle screws fixation in the treatment of the degenerative lumbar disease

目的:比较单侧经皮关节突椎弓根螺钉联合对侧钉棒固定与双侧钉棒系统固定治疗下腰椎退行性疾病的疗效。方法:2009年1月至2012年6月,收治46例下腰椎退变性疾病患者,男30例,女16例;年龄32~71岁,平均51.5岁;单节段40例,双节段6例。按固定方式不同分成两组:其中采取单侧经皮关节突椎弓根螺钉联合对侧钉棒固定治疗22例(A组),采用双侧钉棒系统固定治疗24例(B组)。比较两种术式术中失血量、手术时间等情况,同时对手术前后腰椎Oswestry功能障碍指数(ODI)评分、日本骨科协会(JOA)评分进行比较,评估患者的症状缓解情况。结果:所有患者获得随访,时间1~3年,平均22个月。两组中各有1例不能明确外,其余均获得骨性融合,未出现内植物移位或断裂等并发症;手术时间和出血量A组优于B组(P<0.05);两组患者ODI评分及JOA评分较术前均得到明显改善(P<0.05),但两组间差异无统计学意义(P>0.05)。结论:对无严重不稳的下腰椎退变性疾病患者,两种内固定方法的效果相似,同时单侧经皮关节突椎弓根螺钉联合对侧钉棒固定术具有创伤小、手术时间短、术中失血量少等优点,是一种安全、可行的手术方法。

Objective：To investigate the surgical outcome of unilateral pedicle screw （UPS） after TLIF technique com- bined with contralateral percutaneous transfacet screw （PTS） fixation vs bilateral pedicle screws （BPS） fixation in treatment of degenerative lumbar disease. Methods：From January 2009 to June 2012,46 patients with degenerative lumbar diseases,in- cluding 30 males and 16 females with an average age of 51.5 years old, who were divided into two groups according to different fixation methods. Twenty-two cases underwent UPS after TLIF technique combined with contralateral PI＇S fixation （group A）, while the others underwent BPS fixation （group B ）. The relative data were analyzed, such as blood loss volume, operative time, fusion rate, ODI score, JOA score and so on. Results：All the patients were followed up for 1 to 3 years with an average of 22 months. Except one case of each group was uncertainty fusion, the rest have obtained bony fusion, and the fusion rates in group A and B were 95.5% and 95.8% ,respectively. No displacement and breakage of screw were found during follow-up. Operative time and blood loss volume in group A were better than of group B （P〈0.05）. ODI and JOA scores had improved obviously than preoperation （P〈0.05）, but the differences had no statistical significance between two groups （P〉0.05）. Conclution ：Two ap- proaches had similar clinical outcomes for degenerative lumbar disease with no severe instability. Compared with BPS fixation, the UPS after TLIF technique and contralateral FIS fixation has the advantages of less trauma, shorter operative time and less blood loss, and it is a safe and feasible surgical technique.