髓核摘除单侧内固定椎间融合术治疗腰椎间盘突出症早期疗效

The primary clinical outcomes of lumbar interbody fusion with unilateral pedicle screw fixation

中文关键词:  单侧内固定  腰椎间盘突出症  疗效

英文关键词:Ｕnilateral pedicle screw fixation  Ｌumbar disc herniation  Ｃlinical outcomes

中文摘要:

  【摘要】 目的：比较单侧及双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的初期临床疗效，探讨单侧内固定的可行性。方法：2008年3月～2009年6月在我科行髓核摘除椎体间融合固定术治疗的单间隙腰椎间盘突出症患者共54例，其中行单侧内固定22例，平均随访20.3个月；双侧内固定32例，平均随访19.5个月。对比分析两组患者一般资料、手术时间、出血量、住院天数、住院费用、疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）、融合率及并发症情况。结果：两组患者的术前一般资料（性别、年龄、手术节段）无统计学差异，术前VAS评分及ODI评分单侧组分别为7.23分和42.36分，双侧组分别为6.96分和41.88分，两组无统计学差异（Ｐ＞0.05）；末次随访时VAS评分及ODI评分单侧组分别为2.77分和16.82分，双侧组分别为2.91分和18.75分，与术前比较均具有统计学差异（Ｐ＜0.05），但两组间比较无显著性差异（Ｐ＞0.05）。单侧组手术时间比双侧组平均减少22min，出血量平均减少57ml，住院费用平均减少6007元，两组住院天数无差异。结论：单侧内固定椎间融合治疗单间隙腰椎间盘突出症能够达到双侧内固定同样的疗效，且具有手术时间短、出血量少、费用低等优点。

英文摘要:

  【Abstract】 Objective：To explore the clinical outcomes of unilateral pedicle screw fixation compared with the classic bilateral fixation for the treatment of lumbar disc herniation.Method：Fifty-four patients with single-level lumbar disc herniation were randomized into 2 groups：group 1（n=32） with classic bilateral instrumentation，and group 2（n=22） with unilateral instrumentation.The demographic（sex，age and segment），pre- and post-operative data（operation time，blood loss，hospital day，average cost，ＶＡＳ　and ODI scores） of two groups were compared.Result：No significant difference was found in the demographic data of two groups.The pre-operative VAS of group 1 was 6.96 and ODI score was 41.88，while pre-operative VAS of group 2 was 7.23 and ODI score was 42.36.In the last follow-up，the VAS of group 1 declined to 2.91 and ODI score 18.75，while VAS of group 2 declined to 2.77 and ODI score 16.82.The follow-up data had statistical significance compared with pre-operative scores（Ｐ＜0.05），but no statistical significance between the two groups（Ｐ＞0.05）.Group 2 had shorter operation time（79.8min vs 102.2min），less blood loss（160.9ml vs 217.2ml） and lower cost （￥27444 vs ￥33451） compared with group 1.Conclusion：The unilateral fixation has the same effectiveness as bilateral fixation for the treatment of single-level lumbar disc herniation，and causes lower cost，shorter operative time and less blood loss.