微创下单侧椎弓根钉固定与传统开放式双侧固定在单间隙腰椎管狭窄症的疗效对比

Comparison of the effects of minimally invasive single lateral pedicle screw fixation and conventional open bilateral fixation in single space lumbar spinal stenosis

目的探讨Quandrant可扩张通道下单侧椎间孔作双侧减压、单侧固定治疗单间隙腰椎管狭窄症的临床优势。方法于2013-06-2015-03,共纳入70例单间隙腰椎管狭窄症患者,依据其手术方案的不同,分为两组:微创组31例,均采用单侧椎间孔作双侧减压、联合单侧椎弓根钉固定椎间融合手术;开放组39例,采用传统的开放式双侧减压、双侧椎弓根钉固定椎间融合手术。对两组患者手术前后的相关指标进行对比。结果微创组的手术时间和住院时间,均明显短于开放组;同时,微创组的术中出血量显著少于开放组,上述差异均有统计学意义(P<0.05)。所有患者均获得随访21-35个月,平均25.1个月。末次随访时,两组患者腰、腿痛VAS评分和ODI指数均较术前有显著性降低(P<0.05);组间相比,微创组术后的腰痛VAS评分改善更为明显(P<0.05),其余指标则无显著性差异。在椎间融合率方面,虽然微创组稍逊于开放手术组(93.5%VS100%),但无统计学差异(P>0.05)。结论采用单侧入路双侧减压联合单侧固定椎间融合手术治疗单间隙的腰椎管狭窄症,其创伤小,可取得与双侧开放手术相近的疗效,是一种安全可行的手术方案。

Objective To investigate the clinical advantages of unilateral decompression and unilateral fixation for unilateral lumbar spinal stenosis under Quandrant expandable channels. Methods From June 2013 to March 2015, a total of 70 patients with lumbar spinal stenosis were selected. According to the different operation plan, the patients were divided into two groups. The minimally invasive group （31 cases） was treated with unilateral transforaminal decompression, bilateral and unilateral pedicle screw fixation. And 39 cases of open group were treated by the opening of bilateral decompression the traditional bilateral pedicle screw fixation. The relative indicators of the two groups before and after operation were compared. Results The operation time and hospitalization time of the minimally invasive group were significantly shorter than those of the open group. At the same time, the amount of bleeding in the minimally invasive group was significantly less than that in the open group, and the differences were statistically significant （P〈0.05）. All patients were followed up for 21-35 months, with an average of 25.1 months. At the end of the follow-up, the lumbar and leg pain VAS score and ODI index of two groups were significantly decreased （P〈0.05）, the postoperative low back pain VAS score of minimally invasive group improved more significantly than open group （P〈0.05）. There were no significant differences in other indicators. Although the rate of interbody fusion of minimally invasive group was slightly inferior to the open surgery group （93.5% vs 100%）, but there was no statistically significant difference （P〉0.05）.Conclusion Unilateral decompression combined with unilateral fixation for the treatment of lumbar spinal stenosis with single gap is a safe and feasible surgical procedure with less trauma and comparable results with bilateral open surgery.