Treatment Of Lumbar Disc Herniation With Intervertebral Instability By Unilateral Screw-rod Fixation And 270 Degree Composite Bone Grafting

ObjectiveTo investigate the effect of unilateral screw-rod fixation and 270 degree composite bone grafting in the treatment of lumbar disc herniation with intervertebral instabilityMethodsSixty-eight patients with lumbar disc herniation and intervertebral instability were selected from the Department of Orthopaedics,First Affiliated Hospital of Henan University from September 2016 to June2018.They were divided into two groups: group A(38 cases),treated by 270 degrees composite bone grafting with unilateral screw-rod fixation;group B(30 cases),treated by unilateral screw-rod fixation and intervertebral fusion?The operation time and bleeding volume of the two methods were compared,and the operation effect was evaluated according to the height change of intervertebral space before and after operation,VAS score,ODI score,JOA score and the incidence and adverse rate of complications.The patients were followed up 1 month,3 months and6 months after operation.The relative height of intervertebral space and the fusion rate of bone graft were evaluated with SUK method through lumbar plain film and CT.Results1.There was no significant difference in operation time and bleeding volume between the two methods(P > 0.05).2.The height of lumbar intervertebral space after operation,the height of lumbar intervertebral space after 1 month,the height of lumbar intervertebral space after 3 months and the height of lumbar intervertebral space after 6 months were compared with that before operation.It was found that the height of lumbar intervertebral space after operation of the two methods was significantly higher than that before operation,and the difference was statistically significant(P < 0.01).The height of intervertebral space can be restored and maintained after operation.However,there was no significant difference in the height of lumbar intervertebral space between the two groups before,after,1 month,3 months and 6 months after operation(P > 0.05),indicating that the two methods have the same effect in restoring lumbar intervertebral space.3.The VAS score,ODI score,JOA score of lumbar spine of patients with two kinds of operation methods at 1 month,3 months and 6 months after operation were significantly improved compared with those of patients before operation(P<0.05).The difference was significant(P<0.05).It showed that the clinical symptoms of patients with two kinds of operation methods could be significantly improved and the curative effect was definite.However,there was no significant difference in VAS,ODI and JOA scoresbetween the two groups before operation,1 month after operation,3 months after operation and 6 months after operation(P > 0.05),indicating that the two surgical methods had the same clinical effect.4.Comparing the fusion rate of unilateral screw-rod fixation and 270 degree composite interbody fusion with unilateral screw-rod fixation by lumbar CT and anterolateral lumbar plain film at 1 month,3months and 6 months after operation,it was found that there was no bone graft fusion in the two surgical methods at 1 month after operation,but the rate of unilateral screw-rod fixation and 270 degree composite interbody fusion at 3 months and 6 months after operation was compared with that of unilateral screw-rod fixation and 270 degree composite bone graft.There was significant difference in the fusion rate between unilateral screw-rod fixation and interbody fusion(P < 0.05).It indicated that the 270 degree composite bone graft with unilateral screw-rod fixation had a higher fusion rate than unilateral screw-rod fixation.5.There was no significant difference in the incidence of postoperative complications between the two groups(P > 0.05).It shows that both of the two surgical methods can make the patients achieve rapid clinical healing.ConclusionThe treatment of lumbar disc herniation with intervertebral instability by unilateral screw-rod fixation and 270 degree composite bone grafting can achieve clinical healing and definite effect,improve the clinical symptoms and quality of life of the patients,and the treatment of 270 degree interbody fusion with unilateral screw-rod fixation have advantages of stronger fixation,higher rate of interbody fusion.