单侧与双侧椎弓钉固定腰椎后路椎体间融合比较△

Posterior lumbar interbody fusion with unilateral versus bilateral pedicle screw fixations for lumbar degenerative diseases

摘要:

[目的]比较单侧和双侧椎弓根钉棒内固定后路腰椎间融合术（posterior lumbar interbody fusion, PLIF）治疗腰椎退变性疾病的疗效。[方法] 回顾性分析 2018 年 8 月—2021 年 6 月本院采用 PLIF 治疗腰椎退变性疾病 90 例患者的临床资料。根据术前医患沟通结果，48 例采用单侧固定，42 例采用双侧固定。比较两组围手术期、随访及影像指标。[结果]单侧组在手术时间 [(108.3±10.7) min vs (155.8±17.1) min, P＜0.05]、术中失血量 [(121.2±18.4) ml vs (186.7±18.3) ml, P＜0.05]、住院时间 [(10.2±3.4) d vs (11.8±3.7) d, P＜0.05] 均显著少于双侧组，但两组切口长度、术中透视次数、下地行走时间、切口愈合等级的差异均无统计学意义（P＞0.05）。随访时间平均（29.1±6.2）个月。两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随着时间推移，两组患者腰痛及腿痛 VAS 评分、 ODI 及 JOA 评分均显著改善（P＜0.05）。术后 6 个月单侧组的 ODI [(25.5±6.2)% vs (28.5±7.4)%, P＜ 0.05] 和 JOA 评分 [(20.5±2.2) vs (19.6±1.8), P＜0.05] 显著优于双侧组，但两组之间 VAS 评分差异无统计学意义（P＞0.05），末次随访时，两组上述评分的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后 6 个月及末次随访时，两组椎间隙高度、前凸 Cobb 角均显著改善（P＜0.05），相应时间点，两组间上述影像指标及融合率的差异均无统计学意义（P＞0.05）。[结论]单侧椎弓根钉棒内固定联合椎间融合术可重建患者脊柱稳定性，恢复患者脊柱功能，可以减少手术损伤。

Abstract:

[Objective] To compare the clinical efficacy of posterior lumbar interbody fusion (PLIF) with unilateral versus bilateral pedicle screws fixations for lumbar degenerative diseases. [Methods] A retrospective study was done on 90 patients who received PLIF for lumbar degenerative diseases in our hospital from August 2018 to June 2021. According to preoperative doctor-patient communication, 48 patients underwent unilateral fixation, while other 42 patients underwent bilateral fixations. The perioperative period, follow-up and imaging documents were compared between the two groups. [Results] The unilateral group proved significantly superior to the bilateral group in terms of operation time [(108.3±10.7) min vs (155.8±17.1) min, P＜0.05], intraoperative blood loss [(121.2±18.4) ml vs (186.7±18.3) ml, P＜ 0.05] and hospital stay [(10.2±3.4) days vs (11.8±3.7) days, P＜0.05], despite statistically insignificant differences in incision length, intraoperative fluoroscopy times, walking time and incision healing grade between the two groups (P＞0.05). The average follow-up time was (29.1± 6.2) months, and there was no a significant difference between the two groups in the time to return to full weight-bearing activities (P＞0.05). The VAS scores of low back pain and leg pain, as well as ODI and JOA scores significantly improved in both groups over time (P＜0.05). At 6 months after surgery, the unilateral group was significantly better than the bilateral group regarding to ODI [(25.5±6.2)% vs (28.5±7.4)%, P＜ 0.05] and JOA scores [(20.5±2.2) vs (19.6±1.8), P＜0.05] regardless of insignificant difference in VAS score between the two groups (P＞0.05), whereas all abovesaid clinical scores became not statistically significant between the two groups at the last follow-up (P＞0.05). Radiologically, the vertebral space height and lordotic Cobb angle significantly improved in both groups at 6 months after surgery and at the last followup compared with those preoperatively (P＜0.05). However, there were no statistically significant differences in the above image indexes and fusion rate between the two groups at any time points correspondingly (P＞0.05). [Conclusion] The unilateral pedicle screw fixation PLIF does restore spinal stability, restore spinal function and reduce surgical injury in this study.