【摘要】 目的:探讨椎弓根螺钉单侧固定与双侧固定治疗腰椎间盘突出症对邻近节段退变的影响,并对比其临床疗效。方法:回顾性分析2006年3月至2008年10月分别采用椎弓根螺钉单侧固定和双侧固定治疗的101例腰椎间盘突出症患者的病例资料,男40例,女61例;年龄18~62岁,中位数49岁;突出节段均为L4~5;病程2~9年,中位数5年。单侧固定42例,双侧固定59例。比较2组患者腰椎功能恢复情况及术后邻近节段退变发生情况。结果:2组患者第1头侧及尾侧邻近节段退变发生率比较,组间差异无统计学意义(χ2=2.721,P=0.099);但双侧固定组第2头侧邻近节段退变的发生率高于单侧固定组,差异有统计学意义(χ2=5.140,P=0.023);2组间Oswestry功能障碍指数评分的差异有统计学意义,单侧固定组腰椎功能恢复优于双侧固定组[(25.6±5.9)分,(28.4±5.2)分;t=-2.503,P=0.014]。结论:对于采用腰椎后路减压椎弓根螺钉内固定椎间融合术治疗的单节段腰椎间盘突出症患者,采用单侧固定术后邻近节段退变的发生率低于双侧固定,尤其是第2头侧邻近节段,且更有利于腰椎功能恢复。更多还原

【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.更多还原