单侧内固定椎间融合术治疗伴 Modic改变的腰椎间盘突出症早期疗效

摘要

Objective To compare clinical effects of lumbar interbody fusion with unilateral and bilateral pedicle screw fixation in lumbar disc herniation with Modic changes. Methods Sixty-four patients with Modic changes were treated by lumbar interbody fusion with unilateral pedicle screw fixation or bilateral pedicle screw fixation,and which were divided into two groups according to internal fixation,for unilateral fixation with 30 cases and bilateral fixation with 34 cases. The clinical effects were evaluated by the scores of visual analog scale ( VAS) and Oswestry disability index ( ODI) . Operating time, blood loss, duration of hospital stay, medical expenses, fusion rates and complication were compared between the two groups. Results All cases were followed up for 14 ~38 months. VAS of legs and back and ODI scores after operation had improved obviously than the preoperative, but the scores showed no signifi-cance difference between two groups(P>0. 05). Compared with bilateral fixed group,unilateral fixed group had shor-ter operation duration,less intraoperative blood loss and lower hospitalization expenses,with statistical difference ( P<0. 05 ) . No significant difference was found between two groups in the hospitalization days, incidence rate of complica-tions and fusion rates (P>0. 05). Conclusions The unilateral fixation has the same effectiveness as bilateral fixa-tion for the treatment of lumbar disc herniation with Modic changes, and it has shorter operation duration,less blood loss and lower hospitalization expenses.%目的：比较单、双侧椎弓根钉固定椎间融合术治疗伴Modic改变的腰椎间盘突出症的早期临床疗效，探讨单侧内固定的价值。方法采用椎间融合内固定治疗64例伴Modic改变的腰椎间盘突出症患者，根据内固定方式不同，分为两组：单侧固定组30例，双侧固定组34例。采用疼痛VAS评分、ODI评分评估两组患者手术后的临床效果，并比较两组患者的手术时间、术中出血量、术后住院时间、住院费用、植骨融合率及并发症情况。结果64例患者均获得随访，时间14~38个月。两组患者腰、腿痛VAS评分及ODI评分均较术前明显改善，两组比较差异无统计学意义(P>0．05)。单侧固定组在手术时间、术中失血量及住院费用方面均优于双侧固定组(P<0．05)；两组患者住院天数、并发症发生率、植骨融合率比较差异无统计学意义(P>0．05)。结论单侧或双侧内固定结合椎间融合治疗伴Modic改变的腰椎间盘突出症早期临床效果相似；单侧固定具有手术时间短、出血量少、费用低等优点。