单、双边内固定结合椎间融合器治疗双节段腰椎间盘突出症的疗效比较

发布时间：2018-09-18 17:40

【摘要】：目的比较单、双侧椎弓根螺钉内固定结合椎间融合器治疗相邻双节段腰椎间盘突出症的临床疗效。方法于2013年12月至2015年12月在南华大学附属南华医院脊柱外科收治的双节段单侧症状的腰椎间盘突出症患者40例。对40例均已行后路单或双侧椎弓根螺钉加椎间cage融合器治疗腰椎间盘突出症的患者资料进行回顾性分析。40个病例分成两组,A组20例施行单侧椎弓根固定,B组20例施行双侧椎弓根固定,对所有病例行患侧半椎板切除,椎管减压,神经根松解及椎间cage植入融合手术。记录A组、B组的手术时间、术中出血、术后引流量及住院天数,通过比较两组患者的手术时间、术中出血量、术后引流量、植骨融合率、住院天数、内置物费用及并发症的发生率。对术前、术后的两组,使用日本骨科协会评分(JOA)和视觉模拟量表评分(VAS)评估研究对象手术前后患者的下肢麻痛及腰痛症状程度,通过所采集的数据,利用统计学软件进行分析,来评判术后改善率,并在随访期间行腰椎正侧位片,末次随访时均行腰椎三维CT,观察植骨融合情况,计算椎间植骨融合率。随访时间为12个月。结果1、术后比较两组的融合率、并发症的发生率,术后两组都达到骨性融合;在并发症方面,单边组出现1例螺帽松动,其余病例均未发现钉棒系统的松动、断裂、cage滑脱、移位或沉降,发现P值0.05,无显著性差异,没有统计学意义;2、两组住院天数方面,发现P值0.05,有显著性差异,有统计学意义;3、术后单侧置钉组的手术时间、术中出血量、术后引流量、内置耗材费用明显低于双侧置钉组,P值0.05,有显著性差异,有统计学意义;4、术后两组的VAS、JOA,与术前比较,有显著性差异(P值0.05),有统计学意义。结论1、单侧、双侧椎弓根置钉内固定结合椎间融合器治疗相邻双节段腰椎间盘突出症的近期临床疗效均满意,腰腿痛症状均可明显改善,两组椎间融合率均高;2、单侧置钉组在手术时间、术中出血量、内置耗材费用、住院天数、术后引流量方面呈优势,而且单边组手术过程相对简单,术中对脊柱解剖结构及周围软组织破坏少;3、单侧3枚椎弓根螺钉内固定结合2个椎间融合器在临床上治疗相邻两节段腰椎间盘突出症在近期内是一种安全可行、且较经济的手术方式。
[Abstract]:Objective to compare the clinical effects of unilateral and bilateral pedicle screw fixation combined with intervertebral fusion cage in the treatment of adjacent double lumbar disc herniation. Methods from December 2013 to December 2015, 40 patients with bilateral unilateral lumbar disc herniation were treated in the Department of Spinal surgery, South China Hospital affiliated to South China University. The data of 40 cases of lumbar disc herniation treated by posterior or bilateral pedicle screw plus intervertebral disc fusion cage were retrospectively analyzed. 40 cases were divided into two groups: group A (n = 20) with unilateral pedicle fixation and group B (n = 20) with unilateral pedicle fixation. Bilateral pedicle fixation was performed. All patients were treated with hemilaminectomy, spinal canal decompression, nerve root release and intervertebral cage implantation fusion. The operation time, intraoperative bleeding, postoperative drainage flow and hospitalization days of group A were recorded. The operative time, intraoperative blood loss, postoperative drainage flow, bone graft fusion rate and hospitalization days were compared between the two groups. The cost of implant and the incidence of complications. Before and after operation, (JOA) and (VAS) were used to evaluate the symptoms of lower extremity anesthesia and low back pain in patients before and after operation. The data were analyzed by statistical software. To evaluate the rate of improvement after operation and to observe the fusion rate of intervertebral bone graft by three dimensional CT, of lumbar vertebrae at the last follow-up period and to evaluate the improvement rate of lumbar vertebrae and lumbar vertebrae anterior and lateral position during the follow-up period and to calculate the fusion rate of intervertebral bone graft. The follow-up period was 12 months. Results 1. The fusion rate and complication rate of the two groups were compared postoperatively, and the bone fusion was achieved in both groups. In the complications, one case of loose nut was found in the unilateral group, and none of the other cases found the loosening of the nail and rod system, and the fracture of cage slippage. Displacement or subsidence, found that P value 0.05, no significant difference, there is no significant difference in the two groups in terms of the number of days in hospital, P value 0.05, there is significant difference, there is statistical significance, postoperative unilateral nail placement group, the operation time, intraoperative blood loss, The cost of internal consumables was significantly lower than that of bilateral nailing group (P < 0.05), there was significant difference between the two groups (P < 0.05). There was significant difference in VAS,JOA, between the two groups after operation (P < 0.05). Conclusion 1. Both unilateral and bilateral pedicle fixation combined with intervertebral fusion cage are satisfactory in the treatment of adjacent double-segment lumbar disc herniation, and the symptoms of lumbago and leg pain can be obviously improved. The rate of intervertebral fusion was high in both groups. The operation time, the amount of blood loss, the cost of built-in consumables, the days of hospitalization, the drainage flow after operation in unilateral nail group were superior, and the operation process of unilateral group was relatively simple. It is safe and feasible to treat adjacent two-segment lumbar intervertebral disc herniation with 3 pedicle screws and 2 interbody fusion cages in the near future. And more economical operation method.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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