| Objective:To investigate and compare the efficacy of the single-piece fusion plus unilateral pedicle screw fixation and the single-piece fusion plus bilateral pedicle screw fixation in lumbar spine instability.Methods:A retrospective analysis from 2009 to 2013 and were followed up and treated over 2 years of lumbar instability 58 cases 60 gaps in the Departments of spinal in our hospital,use the single-piece fusion plus unilateral or bilateral pedicle screw fixation to treat lumbar spine instability.According to the different operation methods,all of the 58 cases were divided into unilateral and bilateral fixation groups.Unilateral fixed group includes 28 patients with 30 gaps,including 12 males and 16 females,aged from 26 to 67 years old(mean 51.25±5.92 years old),13 cases of lumbar disc herniation with lumbar spinal instability,10 cases of degenerative spondylolisthesis,5 cases of isthmic spondylolisthesis in grade Ⅰ;integration of parts of L3～4 gap 3 cases,15 cases of L4～5 clearance,12 cases of L5S1 gap.Bilateral fixed group includes 30 patients with 30 gaps,14 males and 16 females;aged from 41 to 62 years old(mean 51.25 ± 10.05 years old);12 cases of lumbar disc herniation with lumbar spinal instability,14 cases of degenerative spondylolisthesis;4 cases of isthmic spondylolisthesis in grade Ⅰ,integration of parts of L3～4 gap 3 cases,15 cases of integration of parts in L4～5 clearance,12 cases in L5S1 gap.To compare the two groups of cases in perioperative indicators(operation time,blood loss,postoperative drainage and complications),radiographic parameters(relative intervertebral height,lordosis angle changes,fusion rate),the clinical efficacy evaluation and other aspects.Results:Both of the two groups were followed up for 24-30 months(mean25.24±0.17 months).Perioperative indicators of the unilateral fixion group:the operation time was 105.36±13.26 minutes,the blood loss was 423.57±72.531ml,the postoperative drainage was 75.00±20.950ml,none of the cases with postoperative iatrogenic neurological symptoms;the bilateral fixion group:the operation time was 137.33±20.12 minutes,the blood loss was 665.17±85.576ml,and the postoperative drainage 135.00±52.74ml,after the operation,1 case foot dropped.After comparing the fixion group and the unilateral fixation group,the results show that the later one less operation time,less blood loss and less postoperative drainage.All the 60 gaps of in unilateral fixation group and the bilateral fixion group were clear to get fusion after 2 years follow-up,there was no statistically significant fusion rate between the two groups(P>0.05).Relative intervertebral height in the unilateral group,before the operation was 0.83±0.13,after 1.08±0.12,follow-up 1.016±0.114;the bilateral one:before the operation was 0.72± 0.23,after 1.09±0.19,Follow-up 1.00±0.18.The improvement of the degree of lumbar lordosis:unilateral fixed preoperative/postoperative was 4.00±2.16,postoperative/follow-up was 2.86± 1.60;bilateral fixed preoperative/postoperative was 3.60± 1.886,postoperative/follow-up was 2.93± 1.60.Between the two groups,there was no significant difference in relative intervertebral height and lumbar lordosis angle degree of improvement(P>0.05);Compared with the preoperation,the relative height of intervertebral disc after the surgery were not statistically significant(P<0.01),showed that two kinds of internal fixation methods can both effectively increase the relative height of intervertebral disc.According to the JOA score improvement rate(RIS),evaluate the efficacy of the two groups.The unilateral fixation group:23 cases were excellent,5 cases were good;The bilateral fixation group:23 cases were excellent,7 cases were good,there was no statistical significance(P>0.05),which showed there was no difference in clinical efficacy.Conclusion:Use a single piece of fusion plus unilateral pedicle screw fixation in lumbar spine instability with strictly surgical indications,will has less trauma,less bleeding,faster recovery,and reduce the economic costs of the patient,it also has good application value. |
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