中国骨伤Issue(9)：722-725,4.DOI:10.3969/j.issn.1003-0034.2014.09.004
单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症
Treatment of lumbar instability with transforaminal lumbar interbody fusion (with single cage) combined with uni-lateral pedicle screw fixation
摘要
Abstract
Objective:To explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability. Methods:The clinical data of 50 patients with lumbar in-stability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain ,and unilateral primarily or unilateral lower limb ra-diation pain,X ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods,they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group,8 males and 12 females,aged from 26 to 66 years old,2 cases with isthmic spondylolisthesis of degreeⅠ,8 cases with degenerative spondylolisthesis,10 cases with lumbar disc herniation;fusion location with L3,4 was in 1 case,L4,5 was in 12 cases,L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group,14 males and 16 females,aged from 41 to 62 years old,4 cases with isthmic spondylolisthesis of degree Ⅰ,14 cases with degenerative spondylolisthesis,12 cases with lumbar disc herniation;fusion location with L3,4 was in 3 cases,L4,5 was in 15 case,L5S1 was in 12 cases. Operation time,intraoperative blood loss,postoperative drainage,complications were analyzed and intervertebral height,lordosis angle changes,fusion rate and clinical effect were compared between two groups. Results:All incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically,no infection,endo-rachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was found in unilateral fixation group. All patients were followed up from 8 to 18 months with an average of (10.8±4.3)months. Ac-cording to JOA score improvement rate (RIS) to assess clinical effect,all patients got excellent and good results,there was no statistically significant difference between two groups. Two methods can both effectively increase the pathological intervertebral height. Unilateral fixation group was better than bilateral fixation group in aspect of operation time ,intraoperative blood loss and postoperative drainage. Conclusion:With strict indication and good skills,transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability has advantages of smaller traumatic , less blood loss,faster recovery for the patient and can reduce the economic cost.关键词
腰椎不稳/椎弓根钉系统/脊柱融合术/经孔椎体间融合术Key words
Lumbar instability/Pedicle screw system/Spinal fusion/Transforaminal lumbar interbody fusion引用本文复制引用
华永均,王人彦,郭志辉,朱利民,陆建阳..单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症[J].中国骨伤,2014,(9):722-725,4.基金项目
浙江省中医药重点学科建设资助项目（编号2012-XK-D03）Fund programZhejiang TCM key discipline construction funded projects （）
