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[1]林斌,黎秋生,何勇,等.椎弓根螺釘單側(cè)固定與雙側(cè)固定治療腰椎間盤突出癥 對鄰近節(jié)段退變的影響[J].中醫(yī)正骨,2015,27(01):16-19.
　LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):16-19.
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椎弓根螺釘單側(cè)固定與雙側(cè)固定治療腰椎間盤突出癥 對鄰近節(jié)段退變的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年01期
頁碼:
16-19
欄目:
臨床研究
出版日期:
2015-01-15

文章信息/Info

Title:
Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation
作者:
林斌; 黎秋生; 何勇; 郭志民
中國人民解放軍175醫(yī)院/廈門大學附屬東南醫(yī)院,福建 漳州 363000
Author(s):
LIN Bin; LI Qiusheng; HE Yong; GUO Zhimin
The 175th Hospital of PLA/The Affiliated Dongnan Hospital of Xiamen University,Zhangzhou 363000,Fujian,China
關(guān)鍵詞:
腰椎;  椎間盤移位;  脊柱融合術(shù);  手術(shù)后并發(fā)癥
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  spinal fusion;  postoperative complications
摘要:
目的:探討椎弓根螺釘單側(cè)固定與雙側(cè)固定治療腰椎間盤突出癥對鄰近節(jié)段退變的影響,并對比其臨床療效。方法:回顧性分析2006年3月至2008年10月分別采用椎弓根螺釘單側(cè)固定和雙側(cè)固定治療的101例腰椎間盤突出癥患者的病例資料,男40例,女61例; 年齡18～62歲,中位數(shù)49歲; 突出節(jié)段均為L4～5; 病程2～9年,中位數(shù)5年。單側(cè)固定42例,雙側(cè)固定59例。比較2組患者腰椎功能恢復情況及術(shù)后鄰近節(jié)段退變發(fā)生情況。結(jié)果:2組患者第1頭側(cè)及尾側(cè)鄰近節(jié)段退變發(fā)生率比較,組間差異無統(tǒng)計學意義(χ2=2.721,P=0.099); 但雙側(cè)固定組第2頭側(cè)鄰近節(jié)段退變的發(fā)生率高于單側(cè)固定組,差異有統(tǒng)計學意義(χ2=5.140,P=0.023); 2組間Oswestry功能障礙指數(shù)評分的差異有統(tǒng)計學意義,單側(cè)固定組腰椎功能恢復優(yōu)于雙側(cè)固定組[(25.6±5.9)分,(28.4±5.2)分; t=-2.503,P=0.014]。結(jié)論:對于采用腰椎后路減壓椎弓根螺釘內(nèi)固定椎間融合術(shù)治療的單節(jié)段腰椎間盤突出癥患者,采用單側(cè)固定術(shù)后鄰近節(jié)段退變的發(fā)生率低于雙側(cè)固定,尤其是第2頭側(cè)鄰近節(jié)段,且更有利于腰椎功能恢復。
Abstract:
Objective:To explore the effect of unilateral fixation and bilateral fixation with pedicle screws on adjacent segment degeneration(ASD)in patients with lumbar disc herniation(LDH)and compare the clinical curative effects between the two kinds of surgery.Methods:The medical records of 101 patients with LDH(L4-5)were analyzed retrospectively.The patients consisted of 40 males and 61 females,and ranged in age from 18 to 62 years(Median=49 yrs).The course of disease ranged from 2 to 9 years(Median=5 yrs).The unilateral fixation was performed in 42 patients and bilateral fixation was performed in 59 patients.Lumbar spine function restoration and postoperative adjacent segment degeneration were reviewed and compared between the 2 groups.Results:There was no statistical difference in incidence of degeneration of the first cephalic adjacent segment and caudal adjacent segment between the 2 groups(χ2=2.721,P=0.099),while the bilateral fixation group was higher in incidence of degeneration of the 2nd cephalic adjacent segment compared to the unilateral fixation group(χ2=5.140,P=0.023).There was statistical differences in Oswestry Disability Index(ODI)between the 2 groups,and the unilateral fixation group surpassed the bilateral fixation group in the lumbar function recovery(25.6+/-5.9 vs 28.4+/-5.2 points; t=-2.503,P=0.014).Conclusion:For patients with single segment LDH who are treated with lumbar decompression in posterior access and pedicle screw internal fixation and intervertebral fusion,the incidence of ASD of unilateral fixation is lower than that of bilateral fixation,especially for the 2nd cephalic adjacent segment.Furthermore,unilateral fixation with pedicle screws is more conducive to lumbar function recovery.

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備注/Memo

備注/Memo:
2014-10-08收稿 2014-11-17修回
更新日期/Last Update: 2015-01-30