微创单枚椎间融合器单边椎弓根螺钉内固定术治疗腰椎间盘突出症的疗效观察

目的：比较微创单边椎弓根螺钉加单枚椎间融合器和双边椎弓根螺钉加椎间植骨融合术治疗腰椎间盘突出症的临床疗效,探讨微创单边内固定的可行性。方法：选择2009年1月～2012年11月在我科行椎间盘切除椎体间融合内固定术治疗的腰椎间盘突出症患者共43例,其中微创单边内同定18例,平均随访15.8个月;双边内固定25例,平均随访16.3个月。对比分析两组患者的一般资料、手术时间、术中出血、住院天数、住院费用、疼痛视觉模拟评分（VAS）和日本骨科协会评估治疗（JOA）评分、植骨融合率及并发症的发生情况。结果：与单边内固定组比较,双边内固定处理的患者的手术时间明显缩短（P〈0.001）,术中失血量明显减少（P〈0.05）,平均住院费用明显降低（P〈0.05）。而两组之间的住院时间、随访时间、植骨融合率、并发症的发生率以及末次随访时的VAS和JOSA评分比较均无统计学差异（P〉0.05）。结论：单边内固定椎间融合治疗单间隙腰椎间盘突出症能够达到双边内固定同样的疗效,且具有手术时间短、出血量少、费用低等优点,但手术适应症需严格控制。

Clinical Research on the Efficacy of Minimally Invasive Unilateral Pedicle Screw Fixation plus Single Cage for the Lumbar Disc Herniation

Objective： To compare the clinical efficacy of minimally invasive unilateral pedicle screw fixation plus single cage with the classic bilateral fixation for the treatment of lumbar disc herniation.Methods： Forty-three cases with single-level lumbar disc herniation were randomly divided into 2 groups： Group 1（n=18） with minimally invasive unilateral pedicle screw fixation plus single cage,and Group 2（n=25） with classic bilateral instrumentation.The demographic（sex,age and segment）.pre-and post-operative data（operation time,blood loss,hospital day,average cost,VAS and JOA scores）of two groups were compared.Results： Compared with the patients treated by minimally invasive unilateral fixation,the operation time of patients treated by classic bilateral fixation was significantly shortened（P0.05）,intra-operative blood loss was evidently decreased（P0.05） and average hospital cost was markedly reduced（P0.05）.No significant difference was found in the hospital stay,duration of follow-up,fusion rate,incidence rate of complications and VAS as well as JOSA scores at the last follw-up visit between two groups.Conclusion： The minimally invasive unilateral pedicle screw fixation plus single cage was characterized by simpler operation,lower blood loss,shorter operation time and little interference to the spine,which was a better method for the treatment of lumbar disc herniation.