Lin Bin, Xu Yang, He Yong, Zhang Bi, Lin Qiuyan, He Mingchang
Orthopedics. 2013 Aug;36(8):e1071-6. doi: 10.3928/01477447-20130724-26.
Minimally invasive unilateral pedicle screw fixation for the treatment of degenerative lumbar diseases has won the support of many surgeons. However, few data are available regarding clinical research on unilateral pedicle screw fixation associated with minimally invasive techniques for the treatment of lumbar spinal diseases. The purpose of this study was to evaluate clinical outcomes in a selected series of patients with lumbar degenerative diseases treated with minimally invasive unilateral vs classic bilateral pedicle screw fixation and lumbar interbody fusion. Patients in the unilateral group (n=43) underwent minimally invasive unilateral pedicle screw fixation with the Quadrant system (Medtronic, Memphis, Tennessee). The bilateral group (n=42) underwent bilateral instrumentation via the classic approach. Visual analog scale pain scores, Oswestry Disability Index scores, fusion rate, operative time, blood loss, and complications were analyzed. Mean operative time was 75 minutes in the unilateral group and 95 minutes in the bilateral group. Mean blood loss was 220 mL in the unilateral group and 450 mL in the bilateral group. Mean postoperative visual analog scale pain score was 3.10±0.16 in the unilateral group and 3.30±1.10 in the bilateral group. Mean postoperative Oswestry Disability Index score was 15.67±2.3 in the unilateral group and 14.93±2.6 in the bilateral group. Successful fusion was achieved in 92.34% of patients in the unilateral group and 93.56% of patients in the bilateral group. Minimally invasive unilateral pedicle screw fixation is an effective and reliable option for the surgical treatment of lumbar degenerative disease. It causes less blood loss, requires less operative time, and has a fusion rate comparable with that of conventional bilateral fixation.
微创单侧椎弓根螺钉固定治疗退行性腰椎疾病已获得许多外科医生的支持。然而，关于单侧椎弓根螺钉固定联合微创技术治疗腰椎疾病的临床研究数据较少。本研究的目的是评估一系列选择的腰椎退行性疾病患者，采用微创单侧与经典双侧椎弓根螺钉固定及腰椎椎间融合术的临床疗效。单侧组（n = 43）患者采用Quadrant系统（美敦力公司，田纳西州孟菲斯）进行微创单侧椎弓根螺钉固定。双侧组（n = 42）通过经典入路进行双侧内固定。分析视觉模拟量表疼痛评分、Oswestry功能障碍指数评分、融合率、手术时间、失血量和并发症。单侧组平均手术时间为75分钟，双侧组为95分钟。单侧组平均失血量为220 mL，双侧组为450 mL。单侧组术后视觉模拟量表平均疼痛评分为3.10±0.16，双侧组为3.30±1.10。单侧组术后Oswestry功能障碍指数平均评分为15.67±2.3，双侧组为14.93±2.6。单侧组92.34%的患者和双侧组93.56%的患者实现了成功融合。微创单侧椎弓根螺钉固定是治疗腰椎退行性疾病的一种有效且可靠的选择。它导致的失血量更少，所需手术时间更短，融合率与传统双侧固定相当。
