RMAST微创通道下减压椎间融合单边固定与双边固定治疗腰椎间盘突出症疗效比较
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摘要
通过比较RMAST微创通道下单边固定和双边固定椎间Cage植骨融合方法观察治疗腰椎间盘突出症的临床疗效。将40例腰椎间盘突出症患者按手术方法分为两组:观察组(A组,n=20例)采用RMAST微创通道下减压单边椎弓根钉棒内固定联合椎间Cage植骨融合术;对照组(B组,n=20例)采用RMAST通道下双边椎弓根钉棒内固定联合椎间Cage植骨融合术。对比分析A、B两组的一般资料、手术时间、术中出血量、术后引流量、术后下地时间、住院天数、住院费用、VAS评分、ODI评分及并发症,对手术疗效进行评估。评估结果表明:A组术中出血量少于B组,手术时间短于B组,术后下地活动时间长于B组,住院费用低于B组,差异均有统计学意义(P<0.05);术后引流量两组差异均无统计学意义(P>0.05),A组术后3 d、术后3个月及末次随访的VAS评分和ODI评分均显著优于B组,差异有统计学意义(P<0.05)。RMAST微创通道下单边椎弓根钉棒内固定联合椎间Cage植骨融合术治疗腰椎间盘突出症也可获得较好的疗效。
To observe the clinical effect of unilateral and bilateral cage fusion under RMAST minimally invasive approach in the treament of lumbar intervertebral disc herniation. 40 patients with lumbar disc herniation were divided into the observation group(group A, n=20, treated with RMAST minimally invasive channel assisted decompression and unilateral pedicle screw fixation combined with intervertebral Cage bone graft fusion) and the control group(group B, n=20, treated with RMAST minimally invasive channel assisted bilateral pedicle screw fixation combined with intervertebral Cage bone graft fusion).The general data, surgical time, intraoperative blood loss, postoperative drainage volume, postoperative ambulation time, hospital stay, hospitalization expenses, VAS score, ODI score and complications were compared between the two groups.The surgical curative effect was evaluated.The intraoperative blood loss of group A was less than that of group B, the surgical time was shorter than that of group B, the postoperative ambulation time was longer than that of group B, and the hospitalization expenses was less than that of group B(P<0.05).There was no statistically significant difference in postoperative drainage volume between the two groups(P>0.05). The VAS scores and ODI scores of group A at 3 days and 3 months after surgery and at the last follow-up were significantly better than those of group B(P<0.05).Unilateral pedicle screw fixation combined with intervertebral Cage bone graft fusion under RMAST minimally invasive channel is also be effective in the treatment of lumbar disc herniation.
To observe the clinical effect of unilateral and bilateral cage fusion under RMAST minimally invasive approach in the treament of lumbar intervertebral disc herniation. 40 patients with lumbar disc herniation were divided into the observation group(group A, n=20, treated with RMAST minimally invasive channel assisted decompression and unilateral pedicle screw fixation combined with intervertebral Cage bone graft fusion) and the control group(group B, n=20, treated with RMAST minimally invasive channel assisted bilateral pedicle screw fixation combined with intervertebral Cage bone graft fusion).The general data, surgical time, intraoperative blood loss, postoperative drainage volume, postoperative ambulation time, hospital stay, hospitalization expenses, VAS score, ODI score and complications were compared between the two groups.The surgical curative effect was evaluated.The intraoperative blood loss of group A was less than that of group B, the surgical time was shorter than that of group B, the postoperative ambulation time was longer than that of group B, and the hospitalization expenses was less than that of group B(P<0.05).There was no statistically significant difference in postoperative drainage volume between the two groups(P>0.05). The VAS scores and ODI scores of group A at 3 days and 3 months after surgery and at the last follow-up were significantly better than those of group B(P<0.05).Unilateral pedicle screw fixation combined with intervertebral Cage bone graft fusion under RMAST minimally invasive channel is also be effective in the treatment of lumbar disc herniation.
引文
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[11] 唐建华,赵丽丽,黄春明,等.微创通道辅助下减压椎间融合及单侧椎弓根钉内固定治疗腰椎间盘突出症[J].中国骨与关节损伤杂志,2016,31(7):748-749.
[12] 李少辉,王平均,李斌,等.单边内固定联合椎间 cage 植骨融合治疗单侧相邻两节段腰椎间盘突出症[J].临床骨科杂志,2017,20(1):23-25.
[13] YANG M J,SUN G X,GUO S,et al.The biomechanical study of extraforaminal lumbar interbody fusion:A three-dimensional finite-element analysis[J].J Healthc Eng,2017,9,(26):1-8.
[14] 唐鹏,黄耀凯,莫臣强,等.单边和双边椎弓根钉棒内固定融合术对邻近节段退变的影响[J].河北医学,2016,22(10):1638-1640.
[15] 林斌,张文彬,周琴,等.腰椎经后路椎体间融合后单边或双边固定对邻近节段退变的影响[J].中国骨与关节外科,2014,7(6):456-460.
[2] 付金利,安永胜,孙贺,等.Quadrant微创通道下行单边钉棒Cage植骨融合术治疗腰椎间盘突出症临床疗效观察[J].中国医疗设备,2016,31(s1):49-50.
[3] LIANG B,ZHAO J,LI N,et al.Surgical treatment of discogenic low back pain by minimally invasive transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2012,26(3):272-276.
[4] HE S H,MA D J,ZHAO X,et al.Unilateral fixation combined with interbody fusion for the treatment of lumbar degenerative instability via a paraspinal intermuscular approach under MAST Quadrant retractor[J].J Zhongguo Gu Shang,2016,29(5):424-428.
[5] ZENG Z Y,YAN W F,SONG Y X,et al.Case control study on two different surgical approaches combined fixation with lumbar interbody fusion for the treatment of single segmental lumbar vertebra diseases[J].Zhongguo Gu Shang,2017,30(5):417-425.
[6] 杨佳宁,宋有鑫,陈宾,等.通道下MIS-TLIF单侧椎弓根螺钉固定椎间融合治疗腰椎退行性疾病的临床研究[J].中国矫形外科杂志,2016,24(15):1345-1350.
[7] FOGEL GR,TOOHEY JS,NEIDRE A,et al.Is one cage enough in posterior lumbar interbody fusion:a comparison of unilateral single cage interbody fusion to bilateral cages[J].Spinal Disord Tech,2007,20(1):60-65.
[8] KALE A,OZ II,ONK A,et al.Unilaterally posterior lumbar interbody fusion with double expandable peek cages without pedicle screw support for lumbar disc herniation[J].Neurol Neurochir Pol,2017,51(1):53-59.
[9] 何文山,郭德全,韩东杰,等.单边和双边椎弓根钉棒内固定联合椎间融合术治疗腰椎间盘突出症效果比较[J].世界最新医学信息文摘,2016,16(87):69-70.
[10] 范恒俊,王涛,何欢,等.单边和双边椎弓根钉棒内固定联合椎间融合术治疗腰椎间盘突出症效果比较[J].山东医药,2016,56(16):47-49.
[11] 唐建华,赵丽丽,黄春明,等.微创通道辅助下减压椎间融合及单侧椎弓根钉内固定治疗腰椎间盘突出症[J].中国骨与关节损伤杂志,2016,31(7):748-749.
[12] 李少辉,王平均,李斌,等.单边内固定联合椎间 cage 植骨融合治疗单侧相邻两节段腰椎间盘突出症[J].临床骨科杂志,2017,20(1):23-25.
[13] YANG M J,SUN G X,GUO S,et al.The biomechanical study of extraforaminal lumbar interbody fusion:A three-dimensional finite-element analysis[J].J Healthc Eng,2017,9,(26):1-8.
[14] 唐鹏,黄耀凯,莫臣强,等.单边和双边椎弓根钉棒内固定融合术对邻近节段退变的影响[J].河北医学,2016,22(10):1638-1640.
[15] 林斌,张文彬,周琴,等.腰椎经后路椎体间融合后单边或双边固定对邻近节段退变的影响[J].中国骨与关节外科,2014,7(6):456-460.