Zeng Zhong-you, Wu Peng, Sun De-tao, Mao Ke-ya, Zhang Jian-qiao, Ji Jian-fei, Song Yong-xing, Han Jian-fu, Song Guo-hao, Tang Hong-chao
Zhongguo Gu Shang. 2015 Oct;28(10):903-9.
To investigate the advantages and disadvantages of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion with cages in the treatment of two-level lumbar vertebra diseases, by comparing bilateral pedicle screw fixation and interbody fusion with cages.
Forty-nine patients with two-level lumbar diseases who received treatments from June 2009 to December 2011 were included in this study. Among these patients, 23 patients received unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion with cages (combined fixation group) and the remaining 26 patients underwent bilateral pedicle screw fixation and interbody fusion with cages (bilateral fixation group). These patients consisted of 17 males and 32 females, ranging in age from 29 to 68 years old. Among these patients, lumbar intervertebral disc herniation accompanied by the spinal canal stenosis was found in 29 patients, degenerative lumbar disc diseases in 17 patients and lumbar degenerative spondylolisthesis (degree I) in 3 patients. The lesions occurred at L2,3 and L3,4 segments in 1 patient, at L3,4 and L4,5 segments in 30 patients, and at L4,5 segment and L5S1 segment in 18 patients. Wound length, operation time, intraoperative blood loss and postoperative wound drainage were compared between two groups. Intervertebral space height in the lesioned segment before and during surgery and at the latest follow up was also compared between two groups. Before surgery and at the latest follow-up, the Cobb angle of the coronal plane and sagittal plane of the lumbar spine, loosening or breakage of internal fixations, the dislocation of intervertebral cages, and interbody fusion were all evaluated in each group. The visual analogue scale (VAS) was used to measure lumbar incision pain. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the function before surgery and at the latest follow-up.
No wound infection or skin necrosis was observed after surgery in all patients. No cerebrospinal fluid leakage, nerve root injury, cauda equia injury or worsened neural function in the lower limb occurred in all patients during and after surgery. Wound length, operation time, intraoperative blood loss and postoperative wound drainage in the combined fixation group were superior to those in the bilateral fixation group. At postoperative 72 hours, the VAS score in the combined fixation group (1 to 4 points, mean 2.35±1.20) was significantly lower than that in the bilateral fixation group (2 to 5 points, mean 3.11±1.00; P<0.05). All the patients were followed up for 12 to 48 months, with a mean of 29 months. After surgery, intervertebral space height was well recovered in each patient and it was well maintained at the latest follow-up, and there was no significant difference between two groups (P>0.05). During follow-up, pedicle screw and translaminar facet screw loosening, dislocation or breakage and dislocation of intervertebral cages were all not found. At the latest follow-up, the Cobb angle of the coronal plane and sagittal plane of the lumbar spine was obviously improved and was not significantly different between two groups (P>0.05). The lumbar interbody fusion rate was 93.5% and 96.2% in the combined fixation group and bilateral fixation group, respectively, and there was no significant difference between them (P>0.05). There was a significant difference in JOA score between before surgery and at the latest follow-up in each patient (P<0.05), and at the latest follow-up, significant difference in JOA score was found between two groups (P<0.05).
Compared to bilateral pedicle screw fixation and lumbar interbody fusion with cages, unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and lumbar interbody fusion with cages shows advantages including small skin incision, minimal invasion, ease of operation, highly reliable stability, high interbody fusion rate, rapid recovery in the treatment of two-level lumbar vertebra diseases and therefore can be preferred as a treatment method of this disease.
通过比较双侧椎弓根螺钉固定联合椎间融合器融合与单侧椎弓根螺钉固定联合对侧经椎板关节突螺钉固定及椎间融合器融合治疗两节段腰椎疾病的优缺点。
纳入2009年6月至2011年12月接受治疗的49例两节段腰椎疾病患者。其中，23例患者接受单侧椎弓根螺钉固定联合对侧经椎板关节突螺钉固定及椎间融合器融合（联合固定组），其余26例患者接受双侧椎弓根螺钉固定及椎间融合器融合（双侧固定组）。这些患者中男性17例，女性32例，年龄29至68岁。其中，29例患者为腰椎间盘突出症伴椎管狭窄，17例为退变性腰椎间盘疾病，3例为腰椎退变性滑脱（Ⅰ度）。病变位于L2、3和L3、4节段1例，位于L3、4和L4、5节段30例，位于L4、5节段和L5S1节段18例。比较两组患者的切口长度、手术时间、术中出血量及术后切口引流量。同时比较两组患者手术前后及末次随访时病变节段的椎间隙高度。术前及末次随访时，评估每组患者腰椎矢状面和冠状面的Cobb角、内固定松动或断裂、椎间融合器移位及椎间融合情况。采用视觉模拟评分法（VAS）测量腰椎切口疼痛程度。采用日本骨科学会（JOA）评分系统评估术前及末次随访时的功能。
所有患者术后均未发生伤口感染或皮肤坏死。所有患者手术中及术后均未发生脑脊液漏、神经根损伤、马尾神经损伤或下肢神经功能恶化。联合固定组的切口长度、手术时间、术中出血量及术后切口引流量均优于双侧固定组。术后72小时，联合固定组的VAS评分（1至4分，平均2.35±1.20）显著低于双侧固定组（2至5分，平均3.11±1.00；P<0.05）。所有患者随访12至48个月，平均29个月。术后，每位患者的椎间隙高度均恢复良好，末次随访时维持良好，两组间差异无统计学意义（P>0.05）。随访期间，未发现椎弓根螺钉及经椎板关节突螺钉松动、椎间融合器移位或断裂。末次随访时，腰椎矢状面和冠状面的Cobb角明显改善，两组间差异无统计学意义（P>0.05）。联合固定组和双侧固定组的腰椎椎间融合率分别为93.5%和96.2%，两组间差异无统计学意义（P>0.05）。每位患者术前与末次随访时的JOA评分差异有统计学意义（P<0.05），末次随访时，两组间JOA评分差异有统计学意义（P<0.05）。
与双侧椎弓根螺钉固定联合腰椎椎间融合器融合相比，单侧椎弓根螺钉固定联合对侧经椎板关节突螺钉固定及腰椎椎间融合器融合治疗两节段腰椎疾病具有皮肤切口小、创伤小、操作简便、稳定性可靠、椎间融合率高、恢复快等优点，可作为本病的首选治疗方法。
