侧方入路椎间融合技术联合单/双侧椎弓根螺钉内固定治疗腰椎退变性疾病的疗效比较

Unilateral versus bilateral pedicle screw fixation in lateral lumbar interbody fusion in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退变性疾病  侧方入路  腰椎椎体间融合术  临床疗效

英文关键词:Lumbar degenerative disease  Lateral approach  Lumbar interbody fusion  Clinical effect

中文摘要:

  【摘要】 目的：探讨侧方腰椎椎体间融合术（lateral lumbar interbody fusion，LLIF）联合单侧（unilateral pedicle screw fixation，UPS）与双侧（bilateral pedicle screw fixation，BPS）椎弓根螺钉内固定治疗单节段腰椎退行性疾病（lumbar degenerative disease，LDD）的临床效果。方法：回顾性分析2019年1月～2021年12月接受LLIF治疗的65例单节段LDD患者，其中接受UPS治疗的患者14例，接受BPS治疗的患者51例。比较两组患者的手术时间、住院费用、影像学参数[包括椎间盘高度（disc height，DH）、椎间孔高度（foraminal height，FH）、腰椎前凸角（lumbar lordosis，LL）、节段性前凸角（segmental lordosis，SL）、轴向中央管横截面积（axial central canal cross-sectional area，CCA）、椎管矢状径（midsagittal canal diameter，CD）、黄韧带面积（ligamentum flavum area，LFA）、黄韧带厚度（ligamentum flavum thickness，LFT）]、融合率、并发症发生率及临床疗效。结果：UPS组手术时间（80.64±10.87min vs 131.57±11.37min）和住院费用（86463.14±1889.54元 vs 101213.06±4512.54元）显著低于BPS组（P<0.05）。两组术后DH、FH、SL、CD、CCA等影像学参数均较术前显著改善（P＜0.05），但组间比较无显著差异（P>0.05）。UPS组术后即刻右侧LFT显著低于BPS组（2.28±0.71mm vs 2.67±0.49mm，P=0.019）。UPS组融合率为85.7%，BPS组为94.1%，差异无统计学意义（P=0.292）。两组并发症发生率（28.6％ vs 23.5%）无显著差异（P=0.733）。结论：单节段LLIF联合UPS固定治疗LDD在影像学改善、临床疗效及并发症控制方面与BPS固定相当，且具有手术时间短、住院费用低等优势，具有良好的可行性。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of single-level lateral lumbar interbody fusion(LLIF) combined with unilateral pedicle screw(UPS) versus bilateral pedicle screw(BPS) fixation in the treatment of lumbar degenerative disease(LDD). Methods: A retrospective analysis was conducted on 65 patients with LDD who underwent single-level LLIF between January 2019 and December 2021. 14 patients received UPS fixation(UPS group) and 51 received BPS fixation(BPS group). The operative time, hospitalization cost, and imaging parameters including disc height(DH), foraminal height(FH), lumbar lordosis(LL), segmental lordosis(SL), axial central canal cross-sectional area(CCA), midsagittal canal diameter(CD), ligamentum flavum area(LFA), and ligamentum flavum thickness(LFT), as well as fusion rate, complication rate, and clinical outcomes were compared between the two groups. Results: The UPS group was shorter in operative time(80.64±10.87min vs 131.57±11.37min) and lower in hospitalization cost(86463.14±1889.54 yuan vs 101213.06±4512.54 yuan) compared with the BPS group(P<0.05). Both groups showed significant improvements in DH, FH, SL, CD, and CCA after operation, with no significant differences between groups(P>0.05). The immediate postoperative thickness of the right ligamentum flavum was significantly lower in the UPS group(2.28±0.71mm vs 2.67±0.49mm, P=0.019). The fusion rates were 85.7% in the UPS group and 94.1% in the BPS group, with no statistically significant difference(P=0.292). There was no significant difference in complication rates between the two groups(28.6％ vs 23.5%, P=0.733). Conclusions: Single-level LLIF combined with UPS fixation for treating LDD provides comparable imaging improvements, clinical outcomes, and complications control to BPS fixation, while offering the advantages of reduced operative time and lower hospitalization costs, supporting its clinical feasibility.