腰椎退变病极外侧椎间融合单侧与双侧椎弓钉固定比较△（开放获取）

Unilateral pedicle screw fixation versus bilateral counterpart in extreme lateral interbody fusion for lumbar degenerativediseases

摘要:

[目的] 比较极外侧腰椎间融合术（extreme lateral interbody fusion, XLIF） 结合侧卧位单侧椎弓钉固定（unilateralpedicle screw fixation, UPSF） 与俯卧位双侧椎弓钉固定（bilateral pedicle screw fixation, BPSF） 治疗骨量减少腰椎退变患者的临床疗效。[方法] 回顾性分析接受XLIF 手术治疗伴有骨量减少的单节段腰椎退变75 例患者的临床资料。依据术前医患沟通结果，25 例采用UPSF，50 例采用BPSF，比较两组围手术期、随访、影像资料。[结果] 两组手术均顺利完成，UPSF 组手术时间[(73.6±10.6) min vs (84.8±12.2) min, P＜0.001]、切口长度[(9.9±1.3) cm vs (14.0±1.4) cm, P＜0.001]、术中出血量[(63.4±17.2) ml vs(86.7±10.8) ml, P＜0.001]、术中透视次数[(6.2±1.2) 次vs (13.1±1.6) 次, P＜0.001] 均显著少于BPSF 组。随访时间13~24 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）。随时间推移，两组患者腰痛VAS 评分、腿痛VAS 评分、ODI 评分均显著改善（P＜0.05）。术后1 周，UPSF 组腰痛的VAS 评分[(2.5±0.9) vs (2.9±0.7), P＜0.001] 显著优于BPSF 组。影像方面，与术前相比，末次随访时两组椎管面积、椎间隙高度、腰椎前凸角、融合评级均显著改善（P＜0.05），相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。末次随访两组内固定松动的差异无统计学意义（P＞0.05）。[结论] XLIF 结合BPSF 和计算机辅助导航的侧卧位UPSF 治疗骨量减少的腰椎退行性疾病患者均安全有效。与BPSF 相比，UPSF 组术中出血量少、透视次数少、手术时间短，术后恢复快。

Abstract:

[Objective] To compare extreme lateral interbody fusion (XLIF) with unilateral pedicle screw fixation (UPSF) in lateral posi-tion versus bilateral pedicle screw fixation (BPSF) in prone position for the treatment of lumbar degeneration complicated with reducedbone mass. [Methods] A retrospective study was conducted on 57 patients who received XLIF for single-level lumbar degeneration compli-cated with bone mass loss. Based on the preoperative doctor-patients discussion, 25 patients received UPSF, while other 50 patients re-ceived BPSF. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The operation was successfullycompleted in both groups. The UPSF group proved significantly superior to the BPSF group in terms of operation time [(73.6±10.6) min vs(84.8±12.2) min, P＜0.001], incision length [(9.9±1.3) cm vs (14.0±1.4) cm, P＜0.001], intraoperative blood loss [(63.4±17.2) ml vs (86.7±10.8) ml, P＜0.001] and the number of intraoperative fluoroscopy [(6.2±1.2) times vs (13.1±1.6) times, P＜0.001]. The follow-up time was of13~24 months, and there was no significant difference in time to regain full weight bearing activity between the two groups (P＞0.05). TheVAS score of low back pain, VAS score of leg pain and ODI score in both groups were significantly improved over time (P＜0.05), and theUPSF group was significantly better than the BPSF group in VAS score of low back pain [(2.5±0.9) vs (2.9±0.7), P＜0.001] one week aftersurgery. As for imaging, the spinal canal area, vertebral space height, lumbar lordosis angle and fusion rate were significantly improved inboth groups at the last follow-up compared with those preoperatively (P＜0.05), and there were no statistically significant differences in theabove imaging indicators between the two groups at any corresponding time points (P＞0.05). In addition, there was no significant difference in implant loosening between the two groups at the last follow-up (P＞0.05). [Conclusion] XLIF with both BPSF and UPSF under computeraided navigation are safe and effective in the treatment of lumbar degenerative diseases complicated with bone mass loss. Compared withBPSF, the UPSF group had less intraoperative blood loss, less fluoroscopy, shorter operative time and faster postoperative recovery.