摘要
背景:双侧椎弓根螺钉固定已广泛应用于腰椎退变性疾病的治疗,但长期随访发现坚强内固定可导致相邻节段应力增加,退变加速。目的:比较腰椎单侧和双侧椎弓根螺钉固定结合单枚融合器植入术式的安全性及有效性。方法:2009年7月至2010年5月,将在我院治疗的腰椎单节段病变行手术内固定的60例患者分为两组:单侧固定组27例,采用单侧椎弓根螺钉固定附加单枚融合器植入;双侧固定组33例,采用双侧椎弓根螺钉固定附加单枚融合器植入。所有患者术前、术后及末次随访时进行JOA评分和VAS评分评估,比较两组的手术时间、术中出血量、住院时间、JOA评分及VAS评分、融合率、并发症发生率及住院费用。结果:两组随访时间24～30个月,平均26个月。两组JOA评分和VAS评分术后与术前比较均有显著统计学差异(P<0.001)。但单侧固定组术后VAS评分显著低于双侧固定组(P<0.001)。两组在临床疗效满意率、融合率和并发症发生率方面无统计学差异,但在手术时间、出血量、住院天数及住院费用方面有显著统计学差异(P<0.001)。结论:腰椎单侧椎弓根螺钉固定结合单枚融合器植入可以达到与双侧椎弓根螺钉固定相同的手术效果,但可以明显缩短手术时间、减少出血量和住院时间,降低住院费用。
Background： Spinal bilateral pedicle screw fixation is widely used in the treatment of lumbar degenerative disease, but it has been found that rigid internal fixation formed stress shielding effect can increase stress and accelerate the degeneration of adjacent vertebral bodies at long-term follow-up period. Objective： To evaluate the safety and efficacy of unilateral versus bilateral pedicle screw fixation with a single cage in clinic Methods： From July 2009 to May 2010, 60 patients with one level lumbar degenerative disease underwent posterior lumbar interbody fusion （PLIF） with unilateral （group A, 27 cases） or bilateral （group B, 33 cases） pedicle screw fixation with a single cage insertion. JOA score and VAS score were used to assess clinical outcome before surgery, after surgery and at the final foUowup. Operating time, blood loss, duration of hospital stay, clinical outcomes, fusion rates, complication, and medical expenses were compared between the two groups. Results： The mean follow up period was 26 months （range, 24-30 months）. There were significant differences in JOA and VAS scores before and after surgery in all patients （P〈0.001）. Postoperative VAS score in unilateral group was significantly lower than that in bilateral group （P〈0.001）. There were no significant differences with respect to clinical satisfactory, fu- sion rates and complication rates between two groups （P〉0.05）. But there were significant differences in terms of operating time, blood loss, duration of hospital stay and medical expenses （P〈0.001）. Conclusions： Unilateral pedicle screw fixation with a single cage is as effective as bilateral pedicle screw fixation in lumbar spinal fusion. Meanwhile, it can reduce surgery time, blood loss, hospital stay and hospital costs.
出处
《中国骨与关节外科》
2013年第2期126-130,共5页
Chinese Journal of Bone and Joint Surgery
关键词
腰椎
椎弓根螺钉
单侧
腰椎融合
Lumbar vertebrae
Pedicle screw
Unilateral
Lumbar fusion
