单、双侧椎弓根钉内固定结合椎间融合术对腰椎间盘突出症脊柱稳定性的影响

A comparative study of the effects between unilateral and bilateral pedicle screw fixation combined with interbody fusion on the symptoms and spinal stability of patients with lumbar disc herniation

目的对比单、双侧椎弓根钉内固定结合椎间融合术对腰椎间盘突出症病人症状及脊柱稳定性的影响。方法选取2014年10月至2016年6月中国人民解放军第九二医院住院的腰椎间盘突出症接受手术治疗的病人60例,采用随机数字表法分为观察组和对照组各30例。观察组接受单侧椎弓根钉内固定结合椎间融合术,对照组接受双侧椎弓根钉内固定结合椎间融合术。对比两组围手术期相关指标;对比两组手术前后的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评估结果;对比两组椎体融合时间及融合率;对比两组术后脊柱稳定性指标的变化。结果观察组的手术时间、术中出血量、术后引流量、住院费用均显著少于对照组(P<0.05);两组病人术后的VAS评分、ODI评分均显著低于术前(P<0.05);观察组术后10 d、术后3个月的VAS评分、ODI评分均显著低于对照组(P<0.05);两组病人的椎体融合时间、融合率的对比,均差异无统计学意义(P>0.05);观察组术后1年邻近节段退变率为46.67%,显著低于对照组(P<0.05);两组病人术后胸椎后凸角、腰椎前凸角、矢状面平衡、颌眉角的对比,均差异无统计学意义(P>0.05)。结论相对于双侧椎弓根钉内固定,单侧椎弓根钉内固定结合椎间融合术可显著减轻病人的手术创伤和医疗负担,缩短病人术后疼痛缓解和脊柱功能的恢复时间,降低邻近节段的退变风险。

Objective To compare the effects between unilateral and bilateral pedicle screw fixation combined with interbody fusion on symptoms and spinal stability of patients with lumbar disc herniation.Methods 60 patients with lumbar disc herniation in The 92 nd hospital of PLA from Oct. 2014 to Jun. 2016 were randomly divided into experimental group and control group,30 cases in each group.The experimental group received unilateral pedicle screw fixation combined with interbody fusion,while the control group received bilateral pedicle screw fixation combined with interbody fusion.The perioperative indexes of the two groups were compared.The Visual Analogue Scale(VAS)and Oswestry Dability Index(ODI)before and after operation were compared.The fusion time and fusion rate were compared between the two groups The changes of spinal stability indexes were compared between the two groups.Results The operation time,intraoperative bleeding volume,postoperative drainage and hospitalization expenses of the experimental group were significantly less than those of the control group(P<0.05).The VAS and ODI of the two groups were significantly lower than those before operation(P<0.05).The VAS and ODI of the experimental group were significantly lower than those of the control group at 10 days and 3 months after operation(P<0.05).There was no significant difference in fusion time and fusion rate between the two groups(P>0.05).In the experimental group,the degeneration rate of adjacent segments at 1 years after operation was 46.67%,which was significantly lower than that in the control group(P<0.05).There was no significant difference between the two groups in posterior convex angle of thoracic vertebrae,lumbar lordosis angle,sagittal balance,and chin brow vertical angle(P>0.05).Conclusion Compared with bilateral pedicle screw fixation,unilateral pedicle screw fixation combined with interbody fusion can significantly reduce the surgical injury and medical burden,shorten the time of postoperative pain relief and spinal function recovery,and reduce the risk of adjacent segment degeneration.