| ObjectiveTo comparison the middle-term clinical curative effects of unilateral and bilateral pedicle screw fixation and interbody fusion of these two different surgical methods in treating degenerative disease of single se-gment lumbar, and to explore their influence on adjacent segment degenera-tion after surgery.Methods60 cases of single-segment lumbar degenerative diseases were include in this study for retrospective analysis. All of the patients were undergone lumbar post fusion surgical treatment from January 2010 to December 2012 in spinal department of Guangdong TCM Hospital. The patients were divided into two group, the unilateral pedicle screw fixation group (observation group, n=30) and the bilateral pedicle screw fixation group (control group, n=30). Based on the acquisition of preoperative and follow-up relevant data, VAS, JOA, ODI score and though the lumbar X-ray observation interverte-bral fusion rate, and to measure the adjacent segment intervertebral height (H) and lumbar of motion (ROM). And Uses the UCLA intervertebral disc degener-ation classification standard of the lumbar spine X-ray analysis ratings, use SPSS19.0 statistical software to establish a database, and carries on the statistical analysis of data, comparing two groups of preoperative surgery group and the difference between the indicators, to evaluate two operative methods and long-term clinical efficacy. ResultThis study observation group of 30 patients; 22 cases of men,8 cases of women; Aged between 40-81 years, mean age 57.23±9.23 years old; Follow-up time 30-61 months, with an average follow-up was 43.47±7.13 months; Hospi-talization time 8 to 24 days, the average hospitalization time 15.07±4.28 days. Control group 30 cases of patients,18 cases of men, women,12 patients, aged between 30-76, the average age of 58.43±10.79 years of age, and follow-up time of 30-68 months, an average of 54.57±9.77 months; Hospitali-zation time 9-25 days, the average hospitalization time 15.53±days. Between the two groups in gender, age, and follow-up time, the differences between the operation section, length of hospital stay in no statistical signific-ance (P> 0.05).In the observation group a mouth size 4 to 8 cm, with an average of 5.43 ±0.97 cm; The average intraoperative blood loss was 157.00±81.42 ml; The average operation time was 175.90±41.48 min. Controls the operation of mouth size in 8-14 cm, with an average of 10.10±1.45 cm; The average intr-aoperative blood loss was 366.67±153.88 ml; The average operation time was 191.83±35.56 ml. Observation group size, intraoperative blood loss was significantly reduced, with significant difference (P< 0.01). For the diff-erence between the two groups of operation time, statistically insignificant (P> 0.05). Observing group follow-up VAS, JOA, ODI score than preoperative improvement, the VAS score by 5.87±1.22 points preoperatively to follow-up was 1.00±0.74 points; JOA score from 15.43±3.30 points preoperatively to follow-up was 27.40±1.19 points; ODI score decreased from 50.30±19.25 points preoperatively to follow-up score was 3.94±4.70 points. Control group were followed up for VAS, JOA, ODI score more before the operation also have obvious improvement, the VAS score of 6.57±1.19 points down to follow-up was 0.80±0.71; JOA scores by 14.33±2.30 rise to follow-up was 27.37±1.45; ODI score by 43.70±16.96 points to follow-up score was 3.72 ±3.96 points. When two groups of three evaluation index were compared with the preoperative were improved significantly, P< 0.01, statistically sig-nificant meaning. Comparison between the two groups, statistically, P> 0.05, there was no statistically significant difference.Through the last follow-up review DR lumbar lateral slice, according to Bridwell fusion evaluation criteria for grading assessment, the control group did not fusion patients for women; Observation group is one male one female. Observation group the fusion rate was 93.3%, while the control group fusion rate of 96.7%, two groups of fusion rate no statistical difference (P> 0.05).Exists in the two groups of cases were followed up for both upper and lower adjacent segment intervertebral height lower than before, the adjacent segment intervertebral ROM value increased to different extent, the observed group of adjacent segment degeneration in 7 cases, including 5 male,2 female, in control of adjacent segment degeneration there were 9 cases,3 women and six men before and after comparison there are statistically significant differences (P< 0.01), the contrast between the two groups corresponding segment degeneration no statistical difference (P> 0.05).Observation group operation complication rate was 6.7%, including the art of postoperative mouth appear tension blisters in 1 case, to the mouth healing after puncture discharge; Fusion exit and postoperative symptoms, repeatedly revision surgery, fixed on both sides of symptoms after hospital discharge, follow-up found the cage back out again, to row cage removed, symptoms improved discharged from hospital. Control the incidence of compli-cations was 10%,1 case of fusion of emergence and lower limb radioactive symptoms, line overhaul after surgery, symptoms can ease; 1 case of wound hematoma, puncture drew blood stasis parallel compression bandage disappea-red after wound; 1 case of mouth appear fat liquefaction, to strengthen clean dressing, bed after suture, healing discharged from hospital. In the two groups had no dural tear, cerebrospinal fluid leakage, nerve damage, wound infection, screw loosening and fracture, and so on and so forth. ConclusionSingle or double side pedicle screw fixation and intervertebral cage bone graft fusion in the treatment of single segmental lumbar degenerative disease of the application, a good clinical curative effect can be obtained, and both treatment; Unilateral lumbar posterior pedicle screw internal fix-ation more traditional bilateral fixed fusion surgery with small incision, less intraoperative bleeding, shorter operation time and less trauma, as well as the advantages of postoperative function recovered satisfactor-ily;And unilateral fixed can also to a certain extent, reduce the cost of surgical instruments, are more appropriate in the treatment of lumbar degen-erative disease of choice, but the unilateral pedicle internal fixation and prevent and delay the degeneration of adjacent segment, and even accelerate the contralateral small joint degeneration, should be strictly grasp the indications, selection suitable cases. |
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