单、双侧后外侧椎弓根钉置入并植骨融合治疗退变性腰椎滑脱的随机对照

背景：节段融合辅以椎弓根钉置入内固定治疗退变性腰椎疾病可提高融合率。 目的：比较单、双侧椎弓根钉置入内固定并植骨融合治疗退变性腰椎滑脱的临床疗效和融合率。 方法：将退变性腰椎滑脱患者随机分为2组，分别行双侧与单侧椎弓根钉置入内固定并植骨后外侧融合。 结果与结论：两组患者失血量、输血量、住院时间、手术并发症、临床疗效、融合率和对临近间盘的影响方面差异无显著性意义。单侧内固定组手术操作时间较双侧内固定组明显缩短(P < 0.001)。双侧内固定组置入186枚椎弓根螺钉中有3枚穿透皮质刺激神经根而行二次手术；单侧内固定组置入90枚螺钉未发生与螺钉置入相关的并发症。表明退变性腰椎滑脱患者行单侧和双侧椎弓根钉置入并植骨内固定后外侧融合效果相同，但单侧内固定成本费用低、节省手术时间，置钉时穿破椎弓根皮质刺激神经根的风险小。

Unilateral versus bilateral instrumented posterolateral lumbar fusion in degenerative spondylolisthesis: A randomized controlled trial

BACKGROUND: Segment fusion supplemented by pedicle screw fixation for lumbar degenerative diseases can increase the fusion rate. OBJECTIVE: To determine the effectiveness of unilateral pedicle instrumentation in clinical outcome and rate of union in comparison with the classic bilateral system. METHODS: Eighty-two patients were randomized into two groups: Group 1 (n=42) had had bilateral instrumentation, and Group 2 (n=40) had only had unilateral instrumentation. RESULTS AND CONCLUSION: Statistically, there was no significant difference between the two groups in relation to demographics, blood loss, need of transfusion, hospital stay, complications, clinical results, rate of union, and effect on adjacent discs. The operating time needed for Group 2 was significantly shorter than that for Group 1 (P < 0.001). In Group 1, 3 of 186 screws violated the pedicle cortex requiring reoperation because root irritation versus no complication on a total of 90 screws in Group 2. Unilateral instrumentation used for the treatment of degenerative lumbar spondylolisthesis is as effective as bilateral instrumentation when performed in addition to 1- or 2-level posterolateral fusion. The cost of this method is lower, saves time, and reduces possible risk inserting screws in only one side.