摘要
目的:比较经Quadrant通道单侧椎弓根螺钉固定(unilateralpediclescrewfixation,uni-PS)和传统后路双侧椎弓根固定(bilateralpediclescrewfixation,bi-PS)治疗腰椎退行性疾病的临床疗效。方法:2008年10月至2010年10月外科治疗腰椎退行性疾病102例,男67例,女35例;年龄34～69岁,平均51.5岁。所有患者术前有不同程度的下腰部疼痛、单侧下肢放射性疼痛或伴有下肢感觉异常;均行椎弓根固定、椎间融合术。根据固定方式的不同,将患者分成A、B两组:A组50例,采用Quadrant通道辅助下单侧椎弓根钉内固定联合单枚椎间融合器融合术治疗;B组52例,采用传统后路双侧椎弓根固定并单枚椎间融合器融合治疗。应用视觉模拟评分系统(VAS)、Oswestry功能障碍指数评分系统(ODI)评估两组患者术后疼痛及功能恢复情况,并对两组手术时间、出血量、融合率及并发症发生率等进行统计分析。结果:所有患者获得随访,平均随访时间为18.2个月(12～21个月)。A组手术时间为(87.6±25.5)min,术中出血量为(105.7±27.2)ml;腰痛、腿痛VAS评分分别由术前的7.2±1.4、7.9±1.1降至术后1个月的3.2±0.6、3.0±0.7;ODI评分从术前的42.2±11.8降至术后的15.6±2.3;融合率为96.0%(48/50),并发症发生率为4.00%(2/50)。B组手术时间为(160.3±20.5)min,术中出血为(220.6±25.5)ml,腰痛、腿痛VAS评分分别由术前的7.3±1.1、8.1±0.9降至术后1个月的3.3±0.4、3.2±0.3;ODI评分从术前的43.1±12.0降至术后的14.9±2.6;融合率为96.2%(50/52),并发症发生率为5.77%(3/52)。A组手术时间较B组缩短,术中失血量A组较B组减少,差异均有统计学意义;VAS评分、ODI评分、融合率、并发症发生率两组比较差异无统计学意义(P>0.05)。结论:微创单侧椎弓根螺钉固定并单枚椎间融合器治疗腰椎退行性疾病与双侧椎弓根钉固定有同样临床效果,且具有手术时间短、出血量少、融合率高等优点,是一种安全可行的治疗方法。
Objective：To compare the clinical effects of unilateral pedicle screw fixation （uni-PS） assisted by Quadrant system and bilateral pedicle screw fixation （bi-PS） for the treatment of lumbar degenerative diseases. Methods： From October 2008 to October 2010,102 patients with lower back pain, unilateral lower limb radiating pain or paraesthesia were treated with pedicle screw fixation and lumbar interbody fusion. There were 67 males and 35 females with an average age of 51.5 years ranging from 34 to 69 years. The patients were randomly divided into two groups （group A and group B） according to the inter- nal fixation type. The patients of group A （n=50） underwent with minimally transforaminal lumbar interbody fusion （TLIF） and unilateral pedicle screw fixation with one single cage placement assisted by Quadrant system;and the patients of group B （n= 52） underwent with posterior lumbar interbody fusion （PLIF） and bilateral pedicle screw fixation with one single cage place- ment. There were no significant differences between two groups in general information （P〉0.05）. VAS score and ODI score sys- tem were used to evaluate the preoperative and postoperative pain and function recovery. Operative time,volume of blood loss, fusion rate and complication rate were compared and analyzed by statistical test. Results：All the patients were followed up from 12 to 21 months with an average of 18.2 months. In the group A,operative time and volume of blood loss were （87.6± 25.5） min and （105.7±27.2） ml, respectively ; VAS score of low back pain and leg pain, ODI score decreased respectively from preoperative 7.2±1.4,7.± 1.1,42.2± 11.8 to 3.2±0.6,3.0±0.7,15.6±2.3 at one month after operation;the fusion rate was 96.0% （48/50） and the complication rate was 4.00% （2/50）. In the group B,operative time and volume of blood loss were （160.3＋ 20.5 ）min and （220.6＋25.5）ml, respectively ;VAS score of low back pain and leg pain, ODI score decreased respectively from preoperative 7.3±1.1,8.1 ±0.9,43.1 ±12.0 to 3.3±0.4,3.2±0.3,14.9±2.6; the fusion rate was 96.2 % （50/52） and the compli-cation rate was 5.77 % （3/52）. There were no statistically significant differences between the two groups in fusion rate, compli- cation rate, VAS pain and ODI score. Whereas the operative time and blood loss in group A were significantly lower than that of group B. Conclusion：Minimally invasive unilateral pediele screw fixation is a safe and feasible method for the treatment of lumbar degenerative diseases. It is as effective as the bilateral fixation in lumbar spinal fusion. In addition, it has the advan- tages of short operative time, less volume of blood loss, high fusion rate, etc.
出处
《中国骨伤》
CAS
2012年第6期468-473,共6页
China Journal of Orthopaedics and Traumatology
关键词
退行性疾病
腰椎
外科手术
微创性
脊柱融合术
Degenerative diseases
Lumbar vertebrae
Surgical procedures,minimally invasive
Spinal fusion
