单侧椎弓根螺钉联合经椎板关节突螺钉与双侧椎弓根螺钉固定治疗下腰椎退行性疾病:2年随访

摘要

背景:双侧椎弓根螺钉固定合并椎间减压植骨融合是治疗腰椎退行性疾病的经典手术方式,但其可造成腰后部肌肉、韧带等软组织损伤以及邻近节段退变的发生,而经椎板关节突螺钉固定具有其独特的优势.目的:比较单侧椎弓根螺钉联合经椎板关节突螺钉固定与双侧椎弓根螺钉固定两种方法治疗下腰椎退行性疾病的临床疗效.方法:纳入46例单节段下腰椎病变患者,根据内固定方案分为2组,其中A组24例行双侧椎弓根螺钉固定合并椎间融合器植骨术,B组22例行单侧椎弓根螺钉联合经椎板关节突螺钉固定合并椎间融合器植骨术,比较2组患者的手术相关指标和临床疗效.结果与结论:①2组患者均顺利完成手术.2组手术切口长度、手术时间、术中出血量、术后引流量、住院费用比较B组均优于A组,差异均有显著性意义(P<0.05);②2组椎间融合率比较差异无显著性意义(P>0.05);③腰痛目测类比评分与JOA评分:2组术后1周和3,6,12,24个月较术前均显著改善(P<0.05),2组之间比较差异无显著性意义(P>0.05);④结果提示,单侧椎弓根螺钉联合经椎板关节突螺钉固定与双侧椎弓根螺钉固定合并椎间融合器植骨治疗下腰椎退行性疾病均可获得满意的临床疗效;单侧椎弓根螺钉联合经椎板关节突螺钉固定具有创伤小、稳定性好、融合率高和花费少等优点,是治疗下腰椎退行性疾病一种较好的手术选择方式.%BACKGROUND: Bilateral pedicle screw fixation combined with intervertebral decompression and fusion is a classic surgical approach in treatment of lumbar degenerative diseases, but it can cause ligament and other soft tissue damage of lumbar spine and degeneration of the adjacent segments. While translaminar facet screw fixation has its unique advantages.OBJECTIVE: To compare the clinical efficacy of unilateral pedicle screw fixation combined with translaminar facet screw fixation and bilateral pedicle screw fixation for lower lumbar degenerative diseases.METHODS: Forty-six patients with single-level lower lumbar degenerative disease were enrolled, and were then treated with bilateral pedicle screw fixation combined with intervertebral fusion (group A, n=24) or unilateral pedicle screw along with translaminar facet screw fixation and intervertebral fusion (group B, n=22). Afterwards, the clinical indexes and efficacy were compared between two groups.RESULTS AND CONCLUSION: (1) All operations were performed successfully. The length of incision, operation time,intraoperative blood loss, postoperative drainage volume and cost of hospitalization in the group B were significantly superior to those in the group A (P < 0.05). (2) There was no significant difference in the rate of fusion between two groups (P > 0.05). (3) The visual analogue scale and Japanese Orthopaedic Association scores in both groups at 1 week,3, 6, 12 and 24 months postoperatively were significantly improved compared with baseline (P < 0.05), but the scores had no significant differences between two groups (P > 0.05). (4) To conclude, unilateral pedicle screw fixation combined with translaminar facet screw fixation and bilateral pedicle screw fixation both exhibit satisfactory treatment outcomes,while the former holds little trauma, good stability, high fusion rate and less cost, which is a better choice for lower lumbar degenerative diseases.