摘要
目的探讨应用单侧椎弓根钉棒联合单枚聚醚醚酮[poly （ether-ether-ketone），PEEK] Cage治疗腰椎间盘突出症的可行性及临床效果。 方法采用临床随机对照研究，将2006年1月－2012年6月收治的符合选择标准的126例单节段腰椎间盘突出症患者随机分为2组，每组63例，研究组采用单侧椎弓根钉棒联合单枚PEEK Cage治疗，对照组采用双侧椎弓根钉棒联合单枚PEEK Cage治疗。两组患者性别、年龄、病程、侧别、病变节段等一般资料比较，差异均无统计学意义（P 〉 0.05），具有可比性。术后按照Schulte等评价标准评定植骨融合情况，采用Oswestry功能障碍指数（ODI）评价患者生活质量，疼痛视觉模拟评分（VAS）评价患者腰背痛改善情况，Macnab标准评定术后疗效，Emery法测量椎间隙高度。 结果研究组患者切口长度、手术时间、术中失血量、住院时间及住院费用均显著少于对照组（P 〈 0.05）。两组患者均获随访，研究组随访时间12～79个月，平均21.3个月；对照组15～73个月，平均22.6个月。术后前凸及椎间隙高度恢复良好，无内固定物松动、断裂等并发症。研究组和对照组植骨融合时间分别为（6.8 ± 1.3）个月和（7.1 ± 1.2）个月，比较差异无统计学意义（t=1.153，P=0.110）。末次随访时，两组患者椎间隙高度、ODI评分及VAS评分均较术前显著改善（P 〈 0.05）；但两组间术前及末次随访时上述指标差异均无统计学意义（P 〉 0.05）。术后3 个月研究组Macnab腰椎疗效评定为优13例，良47例，可3例，优良率95.23%；对照组为优7例，良38例，可15例，差3例，优良率71.42%；研究组显著优于对照组（χ^2=6.110，P=0.006）。 结论与双侧椎弓根钉棒联合单枚PEEK Cage相比，单侧椎弓根钉棒联合单枚PEEK Cage具有创伤小、固定可靠、手术时间短、出血少、费用少、术后患者可早期下床活动等优点，是治疗单节段腰椎间盘突出症的一种较好选择。
Objective To explore the feasibility and effectiveness of unilateral pedicle screw rod and single poly （ether-ether-ketone） （PEEK） Cage for lumbar intervertebral disc protrusion. Methods A total of 126 cases of single segment of lumbar intervertebral disc protrusion between January 2006 and June 2012 were divided into 2 groups in the randomized clinical trial. Unilateral pedicle screw fixation and single PEEK Cage was used in 63 cases （research group）, and bilateral pedicle screw fixation and single PEEK Cage in 63 cases （control group）. There was no significant difference in gender, age, disease duration, side, and affected segment between 2 groups （P 〉 0.05）. Schulte evaluation criterion was used to assess bone graft fusion, Oswestry disability index （ODI） to estimate the quality of life situation, and visual analogue scale （VAS） to evaluate the improvements of lower back pain. Macnab standards was applied to assess postoperative effectiveness, and Emery ways to measure the height of intervertebral space. Results The incision length, operation time, intraoperative blood loss, hospitalization time, and hospitalization fee in research group were significantly less than those in control group （P 〈 0.05）. The patients were followed up 12-79 months （mean, 21.3 months） in research group, and 15-73 months （mean, 22.6 months） in control group. The postoperative lordosis was recovered well, and the height of intervertebral space was increased. No loosening or breakage of internal fixation occurred. The time of bone graft fusion was （6.8 ± 1.3） months in research group and was （7.1 ± 1.2） months in control group, showing no significant difference （t=1.153, P=0.110）. The height of intervertebral space, ODI score, and VAS score were significantly improved when compared with preoperative ones in 2 groups （P 〈 0.05）, but no significant difference was found between 2 groups at preoperation and last follow-up （P 〉 0.05）. At 3 months after operation, postoperative effectiveness was assessed according to Macnab criterion, the excellent and good rate was 95.23% in research group （excellent in 13 cases, good in 47 cases, and fair in 3 cases） and was 71.42% in control group （excellent in 7 cases, good in 38 cases, fair in 15 cases, and poor in 3 cases）; the research group was significantly superior to control group （ χ 2=6.110, P=0.006）. Conclusion Unilateral pedicle screw fixation and single PEEK Cage has the advantages of small trauma, reliable fixation, shorter operation time, less bleeding, less economic cost, and early off-bed activity time. It can provide a simple and reliable choice in single segmental lumbar intervertebral disc protrusion.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第1期74-78,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腰椎间盘突出症
椎间融合
单侧植入
椎弓根钉棒
Lumbar intervertebral disc protrusion Interbody fusion Unilateral implantation Pedicle screw rod
