单侧与双侧椎弓根螺钉固定联合经椎间孔椎间融合术治疗腰椎退行性疾病的长期疗效比较

Comparison of the long-term outcomes of unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in degenerative lumbar diseases

中文关键词:  椎间融合  单侧  双侧  内固定  退行性疾病

英文关键词:Interbody fusion  Unilateral  Bilateral  Fixation  Lumbar degenerative diseases

中文摘要:

  【摘要】 目的：比较单侧与双侧椎弓根螺钉固定联合经椎间孔椎间融合术（TLIF）治疗腰椎退行性疾病的长期临床疗效。方法：回顾性分析2005年3月～2009年10月采用单侧或双侧椎弓根螺钉联合经椎间孔椎间融合术治疗80例腰椎退行性疾病患者，其中单侧固定38例，男性21例，女性17例，年龄34～68岁，平均52.4岁；双侧固定42例，男性23例，女性19例，年龄32～75岁，平均53.7岁。采用视觉模拟评分（VAS）评估患者术前、末次随访时疼痛情况，Oswestry功能障碍指数评分（ODI）评价疗效，通过影像学测量不同部位椎间隙高度，并评估末次随访时椎体间融合情况以及分析相关并发症。结果：所有患者随访5～8年，平均6.8年。临床疗效的判断标准VAS评分、ODI评分单侧固定与双侧固定无显著差异（P>0.05），但手术前后差异均有显著的统计学意义（P<0.05）。单侧固定与双侧固定在手术前后不同部位椎间隙高度差异无统计学意义（P>0.05），但末次随访时椎间隙高度均较术前改善，且差异具有统计学意义（P<0.05）。融合率单侧固定与双侧固定无显著差异（P>0.05）。影像学检查相邻节段退变发生率单侧固定较双侧固定降低（P<0.05），椎旁肌纤维化发生率单侧固定较双侧固定明显降低（P<0.05）。未发现继发性脊柱侧弯、cage移位及螺钉松动、断裂等并发症发生。结论：单侧或双侧椎弓根螺钉联合经椎间孔椎间融合术治疗腰椎退行性疾病均能获得满意的长期疗效。

英文摘要:

  【Abstract】　Objectives: To compare the long-term outcomes of unilateral versus bilateral pedicle screw fixation(PS) with transforaminal lumbar interbody fusion(TLIF) in degenerative lumbar diseases. Methods: From March 2005 to October 2009, 80 patients with the degenerative disorders of lumbar spine were treated by unilateral versus bilateral pedicle screw fixation(PS) with TLIF, 38 patients(21 males and 17 females; range, 34-68 years, average age 52.4 years) were randomized to the unilateral PS group and 42 patients(23 males and 19 females; range, 32-75 years, average age 53.7 years) to the bilateral PS group. Postsurgical pain and functional results were analyzed by the visual analog scale(VAS) and Oswestry disability index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications． Results: The mean follow-up was 6.8 years, with a range of 5 to 8 years. The most frequently used methods to assess the clinical function were visual analog VAS scores and ODI scores, the pooled data did not reveal any significant difference between the two groups(P>0.05), but statistically significant differences were noted between the preoperative and final follow-up ones(P<0.05). No statistical difference in disc height was noted between preoperation and final follow-up for each group(P>0.05), but the postoperative radiologic indexes of all patients were higher than the preoperative ones(P<0.05)． The fusion rate showed no significant difference between two groups(P>0.05). Pooled estimates revealed that the unilateral group was associated with significantly less incidence of the adjacent segment disease and paraspinal muscle fibrosis(P<0.05). There were no complications such as secondary scoliosis, loss of disc height, cage slippage, screw loosening and internal fixation failure. Conclusions: Lumbar interbody fusion with unilateral pedicle screw fixation is as effective as bilateral pedicle screw fixation.