Xie Youzhuan, Ma Hui, Li Hua, Ding Wei, Zhao Changqing, Zhang Pu, Zhao Jie
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Orthopedics. 2012 Oct;35(10):e1517-23. doi: 10.3928/01477447-20120919-22.
A prospective, randomized clinical study was performed to determine whether unilateral pedicle screw fixation was comparable with bilateral fixation in 1- or 2-segment lumbar interbody fusion. One hundred eight patients with lumbar degenerative diseases were randomly assigned to the unilateral (n=56) or bilateral (n=52) pedicle screw fixation group. Interbody fusion was performed in 1 or 2 levels with 1 cage. Operative time, blood loss, duration of hospital stay, functional outcome, fusion rate, and complication rate were recorded and compared statistically. The patients were followed for 3 years postoperatively.Successful radiographic fusion was documented in all patients. No flexion-extension hypermobility or pedicle screw loosening or breakage occurred during the follow-up period. No significant difference existed between the 2 groups when comparing the union rate, complication rate, and functional outcome scores (P>.05). However, compared with the bilateral pedicle screw group, a significant decrease occurred in operative time, duration of hospital stay, and blood loss in the unilateral group (P<.01). Unilateral pedicle screw fixation was as effective as bilateral fixation when performed in addition to 1- or 2-level lumbar interbody fusion. The authors recommend the use of unilateral fixation in lumbar interbody fusion with 1 cage for lumbar degenerative diseases without major instability.
进行了一项前瞻性随机临床研究，以确定在1节段或2节段腰椎椎间融合术中单侧椎弓根螺钉固定与双侧固定是否具有可比性。108例腰椎退行性疾病患者被随机分配至单侧（n = 56）或双侧（n = 52）椎弓根螺钉固定组。采用1个椎间融合器在1个或2个节段进行椎间融合。记录手术时间、失血量、住院时间、功能结果、融合率和并发症发生率，并进行统计学比较。术后对患者进行3年随访。所有患者均记录到影像学融合成功。随访期间未出现屈伸过度活动、椎弓根螺钉松动或断裂。比较两组的融合率、并发症发生率和功能结果评分时，两组间无显著差异（P>0.05）。然而，与双侧椎弓根螺钉组相比，单侧组的手术时间、住院时间和失血量显著减少（P<0.01）。在1节段或2节段腰椎椎间融合术中加用单侧椎弓根螺钉固定与双侧固定效果相同。作者建议在无严重不稳定的腰椎退行性疾病的单节段腰椎椎间融合术中使用单侧固定。
