单边内固定联合椎间cage植骨融合治疗单侧相邻两节段腰椎间盘突出症

摘要

目的：探讨单侧相邻两节段腰椎间盘突出症应用单边钉棒系统内固定联合椎间cage植骨融合的临床疗效及可行性。方法应用单边椎弓根螺钉固定联合椎间cage植骨融合治疗26例单侧相邻两节段腰椎间盘突出症患者。观察手术时间、术中出血量、植骨融合及并发症的情况。采用疼痛VAS评分和JOA腰腿痛评分评定疗效。结果手术时间60~120 min,术中失血量150~350 ml 。患者均获得随访,时间8~24个月。椎间植骨融合率95%。 VAS评分：术前为6~9(7．5±1．4)分,末次随访时为1~5(2．6±1．2)分,差异有统计学意义(P<0．01)。 JOA评分：术前为8~15(11．8±2．9)分,末次随访时JOA评分为18~27(22．6±5．5)分,差异有统计学意义(P<0．01)。无椎弓根螺钉松动、断裂及融合器后移、沉降等并发症。结论应用单边椎弓根螺钉固定联合椎间cage植骨融合治疗单侧相邻两节段腰椎间盘突出症临床效果满意,具有手术时间短、出血量少、并发症少、腰椎功能恢复好等优点,是一种较为理想的内固定方法。%Objective To study the clinical curative effect and feasibility of the application of unilateral adjacent two segments lumbar intervertebral disc herniation treated with screw rod joint cage system internal fixation and bone graft fusion. Methods Total 26 cases underwent combined cage unilateral pedicle screw fixation and bone graft fusion for treatment of unilateral adjacent two segments lumbar disc herniation. The visual analogue scale ( VAS) and the Japa-nese orthopaedic association ( JOA) lumbocrural pain score function parameters were used to evaluate the effect, op-eration time, intraoperative blood loss, bone graft fusion,and complications of the situation were recorded. Results Operation time was 60~120 min, intraoperative blood loss was 150~350 ml. Follow-up time of patients was 8 ~ 24 months. Intervertebral bone graft fusion rate was 95%. VAS:the preoperative was 6~9 (7. 5 ± 1. 4) points, at last follow-up for 1~5 (2. 6 ± 1. 2) points;the difference was statistically significant (P<0. 01). JOA score:the pre-operative was 8~15 (11. 8 ± 2. 9) points, JOA score at last follow-up of 18~27 (22. 6 ± 5. 5), the difference was statistically significant ( P<0. 01 ) . No looseness or broken pedicle, fusion backwards, settlement, etc occurred. Conclusions The application of combined intervertebral cage unilateral pedicle fixation and bone graft fusion for treatment of unilateral adjacent two segments lumbar intervertebral disc herniation clinical effect is satisfied, there is shorter operation time, blood loss, fewer complications, less lumbar as well as good functional recovery, which is an ideal internal fixation method.