Comparison of three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases: At a mean follow up time of 46 months
Comparison of three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases: At a mean follow up time of 46 months
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DOI：
10.1016/j.clineuro.2015.12.002
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发表时间：
2016-02-01
影响因子：
1.9
通讯作者：
Dong, Jian
中科院分区：
文献类型：
--
作者：
Liu, Fubing;Cao, Yuanwu;Dong, Jian
目的：本研究旨在回顾性比较三种不同的后路固定技术在经椎间孔腰椎椎间融合术治疗双节段腰椎退行性疾病中的应用。患者和方法：这是一项回顾性单中心研究，纳入了84例接受单侧椎弓根螺钉（UPS）、单侧椎弓根螺钉+对侧经椎板关节面螺钉（UPSFS）内固定TLIF的患者，或双侧椎弓根螺钉（BPS）。将患者分为UPS组（n = 22）、UPSFS组（n = 28）和BPS组（n = 34）。记录手术时间、出血量、住院时间、住院费用、融合情况及并发症，并进行统计学分析。使用视觉模拟量表（VAS）、奥斯韦斯特里残疾指数（ODI）和日本骨科协会评分（乔亚）来评估术前和术后疼痛和功能结局。结果：术后随访36 ~ 60个月，平均462个月。UPS组和UPSFS组手术时间、术中出血量、住院费用较BPS组明显减少（p < 0.05）。各组术后平均VAS、ODI和乔亚评分均较术前显著改善（p < 0.05），但在任何随访时间点，两组之间均无显著差异（p > 0.05）。除螺钉/棒失效率（p <0.05）外，两组间融合率和并发症发生率无统计学差异（p > 0.05）。X线片分析显示，所有治疗组的LLS均得到改善（p < 0.05），SL维持结论：UPS或UPSFS内固定TLIF可获得与BPS相当的满意中期临床结局，手术时间短，出血量少，费用低;对于两个节段的病例，在融合率较低的情况下应谨慎进行UPS，UPSFS中应使用更坚固的实心螺钉取代空心螺钉，以减少关节突螺钉断裂。(C)2015 Elsevier B. V.版权所有。
Objectives: This study sought to retrospectively compare three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases.Patients and methods: This was a retrospective single-center study including 84 patients who underwent TLIF instrumented with unilateral pedicle screws (UPS), unilateral pedicle screws plus contra-lateral translaminar facet screws (UPSFS), or bilateral pedicle screws (BPS) between June 2008 and May 2012. These patients were divided into three groups: UPS (n = 22), UPSFS (n = 28) and BPS (n = 34) group. Operative time, blood loss, length of hospital stay, hospital bill, fusion status and complications were recorded and analyzed statistically. Visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Scores (JOA) were used to assess the preoperative and postoperative pain and functional outcome. Sagittal aligment was evaluated by the segment lordosis (SL) and whole lumbar spine lordosis (LL).Results: The mean follow up duration was 462 (ranging from 36 to 60) months. A significant decrease occurred in operative time, blood loss and hospital bill in UPS and UPSFS group, compared with BPS group (p < 0.05). The average postoperative VAS, ODI and JOA scores improved significantly in each group than the preoperative counterparts (p < 0.05), however, there were no significant difference between groups at any follow-up time point (p > 0.05). No statistically difference was detected regarding fusion rate and complication rate between groups (p > 0.05), except the screw/rod failure rate (p < 0.05). Radiographic analysis showed that the LLs in all these groups got improved (p < 0.05) and the SLs maintained (p > 0.05).Conclusion: UPS or UPSFS instrumented TLIF could achieve satisfactory mid-term clinical outcome comparable to BPS's, with less surgical time, less blood loss, and lower cost; UPS should be prudently performed for two-level cases in case of lower fusion rate, and cannulated screws should be replaced by stronger solid screws in UPSFS to reduce facet screw breakage. (C) 2015 Elsevier B.V. All rights reserved.