摘要
目的：探讨单侧神经减压椎间融合椎弓根螺钉固定治疗腰椎退行性疾病的可行性和中期临床疗效。方法：对2005年8月至2010年5月收治并获得随访的56例腰椎退行性疾病患者的临床资料进行回顾性分析。根据固定方法分为两组,其中,单侧组27例,男18例,女9例,年龄41～66岁,平均（57.5±7.1）岁,采用单侧神经减压椎间融合椎弓根螺钉固定治疗;双侧组29例,男19例,女10例,年龄43～68岁,平均（54.6±5.1）岁,在上述基础上加行对侧椎弓根螺钉固定。对两组患者的手术时间、出血量、住院时间和住院费用等进行比较,采用JOA评分评估两组患者临床疗效,随访观察植骨融合情况及融合器相关并发症的发生情况。结果：随访36～60个月,平均45.8个月。两组患者术中均无医源性神经、血管、脏器等损伤。单侧组在手术时间、出血量、住院时间和住院费用等指标上均优于双侧组（P〈0.05）;两组手术前后JOA评分及术后改善率差异无统计学意义（P〉0.05）;末次随访,单侧组融合器移位1例,沉降1例,双侧组透光未融合2例,但差异无统计学意义（χ^2=0.305,P=0.58）.结论：单侧椎间融合椎弓根螺钉固定作为治疗腰椎退行性疾病的一种方法,中期效果满意,但应严格掌握适应证。
Objective：To investigate the feasibility and the mid-term effects of unilateral pedicle screw fixation and transforaminal lumbar interbody fusion in treating lumbar degenerative diseases. Methods：From August 2005 to May 2010, 56 patients with lumbar degenerative diseases underwent lumbar posterolateral fusion, their clinical data were retrospective analyzed. The patients were divided into two groups （unilateral group and bilateral group） according to fixation methods, 27 patients in unilateral group who were underwent unilateral pedicle screw fixation, including 18 males and 9 females with a mean age of （57.5±7.1） years old （ranged from 41 to 66 years）;and 29 patients in bilateral group who were treated with bilateral pedicle screw fixation （on the basis of the above, with contralateral vertebral pedicle screw fixation）, including 19 males and 10 females with a mean age of（54.6±5.1） years old （ranged from 43 to 68 years）. The clinical data such as operation time, blood loss volume, hospitalization time and cost were compared between two groups. JOA score system was used to evaluate the neurological function. And fusion status and cage-related complication were also analyzed. Results：All patients were followed up from 36 to 60 months with an average of 45.8 months. No iatrogenic nerve, blood vessels or organs injury were found during operation. Operation time, blood loss volume, hospitalization time and cost in unilateral group were better than that of bilateral group （P〈0.05）. There was no significant difference in JOA score between two groups （P〉0.05）. Two patients in unilateral group developed with cage related complications, 1 case was cage displacement and 1 case was cage subsidence, while 2 patients in bilateral group developed with complications of no-fusion, and there was no significant differences between two groups （P=0.58）. Conclusion：Unilateral pedicle screw fixation is a satisfactory method and can obtain good effects in treating lumbar degenerative diseases in mid-term, however, the indications should be well considered.
出处
《中国骨伤》
CAS
2015年第4期313-317,共5页
China Journal of Orthopaedics and Traumatology
关键词
腰椎
脊柱融合术
椎弓根螺钉
减压
Lumbar vertebrae
Spinal fusion
Pedicle screws
Decompression
作者简介
通讯作者：刘良乐E—mail：liuliangle@163．com
