| Objective: To compare the fixation lumbar disc herniation spinal interbody fusion with posterior pedicle screw and interbody fusion of the merits alone,provide some evidence-based science basis for the selection and promotion of lumbar disc herniation treatment modalities.Methods: A retrospective analysis of our hospital orthopedic(spine group)in January 2012-LDH patients with single segment in June 2014 were treated 80 cases,depending on the surgical treatment of the spinal fixation by posterior vertebral internal screw-rod Joint fusion between healer to group(48 cases),the simple set alone interbody fusion treatment group(32 cases),the two groups were recorded and observed operation time,intraoperative blood loss,intraoperative complications,surgery After the transfusion,postoperative ambulation time,hospital stay and costs,postoperative complications,postoperative recovery at different time points,the efficacy and fusion cases based on pain visual analog scale,Oswestry Disability Index questionnaire,JOA low back pain scoring system,Suk standards are assessed and recorded,will be collected in line with the positive state of the measurement data(mean ± standard deviation),t-test was used to compare between the two groups;it does not meet the normal metered data with median and quartiles,said the two groups were compared using rank sum test;count data expressed as a percentage,comparison between the two groups using chi-square test.Inspection standards set ?=0.05,P<0.05 statistically difference.Results: The balance of age,body weight,disease duration,gender,disease stage and other groups of patients with good baseline data(P>0.05),comparable;the combined group of patients with operative time,blood loss,transfusion after surgery,were more than the cost of hospitalization alone group(t=12.357,P<0.05;t=6.319,P<0.05;t=8.316,P<0.05;t=3.219,P<0.05);the combined group of patients in the postoperative bed time,length of hospital stay of more than a simple group(t=4.061,P<0.05;t=4.218,P<0.05).As follow-up date,80 patients by telephone and outpatient review were followed up for 12-38 months,with a median follow-up time of 16 months.Two groups of patients before surgery,3 months,6 months,12 months VAS score close(t=2.078,P>0.05;t=1.904,P>0.05;t=1.746,P>0.05;t=1.234,P>0.05);the combined group of patients after one week,one month after the degree of pain is more important than simple group(t=4.913,P<0.05;t=4.361,P<0.05);two groups of patients before surgery,intraoperative After one week,after six months,the difference was 12 months after the Oswestry disability index was not statistically significant(t=1.319,P>0.05;t=1.954,P>0.05;t=1.428,P>0.05;t=1.526,P>0.05);patients combined group 1 and 3 months Oswestry Disability Index better than group(t=6.334,P<0.05;t=7.916,P<0.05);Preoperative JOA score quite(t=1.678,P>0.05);two groups of patients after one week,after six months,12 months after JOA score improvement rate is not having a significant difference(t=1.954,P>0.05;t=0.791,P>0.05;t=1.287,P>0.05);patients combined group 1 and 3 months JOA score improvement rate is better than group(t=10.367,P<0.05;t=8.902,P< 0.05);the combination group and simple group after one week,after one month,six months,12 months JOA score excellent rates were(41.66% vs 40.625%),(58.33% vs 53.125%),(100.00 % vs 100.00%),(100.00% vs 100.00%),no statistically significant difference(?2=1.954,P>0.05;?2=2.037,P>0.05;?2=0.000,?2>0.05;?2=0.000,P>0.05);the combined group after three months JOA score excellent rate to 81.25 percent higher than that group of 71.875%(?2=4.389,P<0.05);The fusion rate of the combined group was better than that of the simple group(45.83% vs 34.38%,?2=4.213,P<0.05)1 months after operation.postoperative joint group and pure fusion rate of 3 and 6 months,respectively It was(47.92% vs 37.50%),(64.58% vs 53.125%),and the difference was significant(?2=4.026,P<0.05;?2=3.864,P<0.05);the combined group after months fusion rate 9,12 respectively,83.33%,91.67% 78.125%,with the simple group 90.625% close(?2=1.037,P>0.05;?2=0.949,P>0.05);surgery due to adhesions heavy release occurs in 3 patients(combination group two cases,one case in the control group)dural tear,were given repair,but the joint group had one case of postoperative cerebrospinal fluid leakage,pressure and added to give the incision low pressure headache does not occur after a sufficient amount of liquid;1 case fixing screws loose,two cases of nerve root injury,one case of urinary retention,two cases of recurrent back pain;simple group occurred in one case of pressure ulcers,one case of urinary retention,one case of deep vein thrombosis,one case of lack of spondylolisthesis ?degree(Meyerding points degrees),one case of Cage slide: The incidence of complications in the combination group 14.58%,and 15.625% pure group of similar(?2=1.015,P>0.05).Conclusion: Posterior spinal fixation interbody fusion with pedicle screw and interbody fusion are simple single segment LDH effective treatment,fixation and interbody spinal fusion with posterior pedicle screw in postoperative hospital stay,bed activity time,recent(within 3 months)symptoms and convergence better than interbody fusion,interbody fusion,but simply have shorter operative time,less blood loss,a small amount of postoperative blood transfusion,pain,hospitalization and low cost advantages,should be considered the treatment of choice in patients with specific conditions. |
PDF Full Text Request