单侧椎板关节突螺钉固定与双侧椎弓根螺钉固定应用于下腰椎退变性疾病的比较

Clinical outcomes of unilateral translamina facet screw fixation vs bilateral pedicle screws fixation for lower lumbar vertebra diseases

中文关键词:  腰椎  椎板关节突螺钉  椎弓根螺钉  内固定  椎间融合

英文关键词:Lumbar vertebra  Lamina facet screw  Pedicle screws  Fixation  Intervertebral fusion

中文摘要:

  【摘要】 目的：比较后路减压椎间融合器植骨后行单侧椎板关节突螺钉固定与双侧椎弓根螺钉固定治疗下腰椎退变性疾病的优缺点。方法：2007年6月～2008年12月采用后路减压椎间融合器植骨内固定治疗51例下腰椎退变性疾病患者，均为单节段病变，无严重不稳。其中26例在瞄准器引导下经皮单侧椎板关节突螺钉固定（A组），25例采用双侧椎弓根螺钉固定（B组）。两组患者性别比例、年龄、病程、疾病类型、病变部位、疾病严重程度和术前病变节段椎间隙高度无统计学差异，比较两组患者手术创伤和临床疗效。结果：两组病例均顺利完成手术，均未输血，术中、术后未出现手术相关并发症。两组手术切口长度、手术时间、术中出血量、术后切口引流液量和住院费用比较差异有显著性差异（P＜0.05），A组优于B组；所有病例均获随访，随访时间12～42个月，平均19．5个月，随访过程中两组病例均未出现螺钉松动、移位、断裂等，融合率无显著性差异（P＞0.05），末次随访时两组JOA评分改善率无显著性差异（P＞0.05）。结论：对无严重不稳的单节段退变性腰椎疾病患者两种内固定方法的效果相当，但相对双侧椎弓根螺钉固定，在瞄准器引导下经皮单侧椎板关节突螺钉固定切口小、创伤小、操作简单、费用低。

英文摘要:

  【Abstract】 Objective：To investigate the surgical outcome of unilateral translamina facet screw fixation vs bilateral pedicle screws fixation after posterior decompression and intervertebral cage fusion for lower lumbar vertebra diseases.Method：51 patients with lower lumbar vertebra diseases who underwent the surgery were reviewed retrospectively，26 cases（group A） underwent unilateral translamina facet screw fixation by gunsight guiding, while the others（group B） underwent bilateral pedicle screws fixation.No significant difference was noted between two groups with respect to sex，age，duration，type of disease，site and degree of disease，and disc height of diseased segment.The clinical outcomes between 2 groups were compared.Result：All operations were performed successfully.No surgery-related complications was noted after operation.There were significant differences between two groups regarding to the length of incision，operation time，intraoperative blood loss，postoperative draining and cost of hospitalization.All cases were followed-up for an average of 19.5 months（range，12-24 months）.48 of 51 cases got bony fusion.No implant failure was noted during the follow-up，and JOA score at the final follow-up showed no difference between 2 groups（P＞0.05）.Conclusion：These two approaches had similar clinical outcomes for single-level lumbar degenerative disorders with no instability，compared with bilateral pedicle screw fixation，percutanous unilateral translamina facet screw fixation is minimal invasive and easy-handling.