单、双侧椎弓根固定在双节段腰椎间盘突出症椎间融合手术中的作用比较

Comparative Analysis of Single and Double Pedicle Fixation in the Operation of Lumbar Disc Herniation

目的 探讨单、双侧椎弓根固定在双节段腰椎间盘突出症椎间融合手术中的应用价值.方法 选取贵州省安顺市中医院2017年2月至2018年6月收治的双节段腰椎间盘突出症患者106例为研究对象,根据治疗方案分为对照组和研究组,各53例.对照组采取双侧椎弓根固定联合椎间融合手术,研究组采取单侧椎弓根固定联合椎间融合手术.统计2组围术期状况、术前及术后第1?d、术后3个月、术后6个月疼痛程度(VAS)分值、术前及术后6个月Oswestry功能障碍指数评分(ODI)及日本骨科协会治疗评分(JOA)、腰椎前凸角及后凸角、并发症发生率.结果 研究组术中失血量、术后引流量少于对照组,手术时长、卧床时间、住院时长均短于对照组(P<0.05);术后第1?d、术后3个月、术后6个月2组VAS分值较术前降低,且研究组低于对照组(P<0.05);术后6个月2组ODI分值较术前降低,JOA分值较术前增高(P<0.05),但组间比较无显著差异(P>0.05);腰椎前后凸角:术后6个月2组腰椎前凸角较术前增大、后凸角较术前减小(P<0.05),但组间比较差异无统计学意义(P>0.05).研究组并发症发生率5.66%,显著低于对照组(18.87%,P<0.05).结论 双节段腰椎间盘突出症椎间融合手术中应用单、双侧椎弓根固定,均可改善患者腰椎前后凸角,恢复其腰椎功能.但单侧椎弓根固定在减少双节段腰椎间盘突出症患者手术创伤方面更具显著优势,利于减轻术后疼痛感,且并发症发生率较低,安全性较高.

Objective To explore the application value of unilateral and bilateral pedicle fixation in interbody fusion for bilateral lumbar disc herniation.Methods Totally 106 patients with double lumbar disc herniation who were admitted to Anshun Hospital of traditional Chinese medicine in Guizhou Province from February 2017 to June 2018 were selected as the study objects.According to the treatment plan,they were divided into control group and study group,53 cases each.The control group was treated with bilateral pedicle fixation combined with interbody fusion,while the study group was treated with unilateral pedicle fixation combined with interbody fusion.The perioperative status,preoperative and postoperative day 1,postoperative 3 months,postoperative 6 months pain degree(VAS)score,preoperative and postoperative 6 months Oswestry dysfunction index score(ODI),Japanese Orthopedic Association treatment score(JOA),lumbar anterior and posterior convex angles,and the incidence of complications were analyzed.Results The amount of blood loss and postoperative drainage in the study group were less than those in the control group,and the length of operation,bed rest and hospitalization in the study group were longer than those in the control group(P<0.05).The VAS score of the first day,three months and six months after operation was lower than that of the control group(P<0.05).At 6 months after operation,ODI score of the two groups was lower than that before operation,JOA score was higher than that before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Six months after operation,the anterior lordosis angle increased and the posterior lordosis angle decreased(P<0.05),but there was no significant difference between the two groups(P>0.05).The incidence of complications in the study group was 5.66%,significanly lower than that in the control group(18.87%,P<0.05).Conclusion The application of unilateral and bilateral pedicle fixation in double-level lumbar intervertebral disc fusion can improve the lumbar lordosis and restore the lumbar function.However,unilateral pedicle fixation has more significant advantages in reducing surgical trauma in patients with bilateral lumbar disc herniation,which is conducive to alleviating postoperative pain,and has lower incidence of complications and higher safety.