摘要目的 对比椎间盘镜下减压单枚与双枚椎间融合器(B-Twin cage)植骨融合术治疗腰椎间盘突出症伴腰椎不稳的疗效.方法 2006年3月至2008年5月,收治腰椎间盘突出症伴腰椎不稳患者45例,其中男性24例,女性21例;年龄43～61岁,平均46.8岁.均为单一节段病变,其中L3-42例,L4-529例,L5～S1 14例,均行后路椎间盘镜下减压B-Twin cage椎间融合术.根据cage数目随机分为单枚组(24例)和双枚组(21例).比较分析两组手术时间,术中出血量,术前及术后1、3、6个月视觉模拟评分法(VAS)评分变化以及术前、术后1个月、末次随访Oswestry功能障碍指数(ODI)和椎间隙高度的变化.结果 43例患者获随访,随访时间1～3年.单枚组平均手术时间、术中出血量均少于双枚组.两组平均住院时间分别为(11.0±3.2)d和(10.9±3.3)d.两组术后VAS评分均较术前明显减小,差异有统计学意义(P＜0.05)且随着随访时间延长分值呈递减趋势,但两组间比较差异无统计学意义(P＞0.05).两组术后及末次随访ODI与术前相比差异均有统计学意义(P＜0.05),但组间比较无明显差异.两组椎间隙高度均维持良好,末次随访时所有患者获骨性融合.单枚组术后出现顽固性腰痛3例,双枚组2例.双枚组有1例侧翼断裂,但无移位及临床症状.结论 椎间盘镜下减压单枚与双枚B-Twin cage椎间融合治疗腰椎间盘突出症伴腰椎不稳,疗效相近,单枚融合术创伤小,花费少,值得推广.

abstractsObjective To compare the therapeutic effect of posterior lumbar interbody fusion by single and double B-Twin expandable spinal spacer with microendoscopic discectomy (MED) for lumbar intervertebral disc protrusion accompanying degenerative instability. Methods From March 2006 to May 2008, 45 patients with lumbar intervertebral disc protrusion accompanying degenerative instability were admitted and managed with posterior lumbar interbody fusion by B-Twin expandable spinal spacer with MED. The patients were randomly assigned to treatment with single B-Twin ( Single group, n = 24) or double B-Twin ( Double group, n = 21 ). There were 16 males and 8 females, with an average age of 45.5 years (43-60 years) in Single group;13 males and 8 females, with an average age of 43.7 years (44-61 years) in Double group. All the cases suffered from only one level disc protrusion, L3-4 2 cases, L4-5 29 cases and L5-S1 14 cases. Clinical outcomes were evaluated with surgical time, blood loss, visual analogue scale (VAS)scores preoperatively, 1,3, 6 month postoperatively. Oswestry disability questionnaire ( ODI ) of the preoperative, 1 month postoperative, and latest follow-up and the disk space heights. Results Forty three patients were followed-up for 1 to 3 years after surgery. The mean surgical time of Double group was longer than Single group [( 152 ±32) min vs. (91 ± 15) min, P ＜0. 01]. The average blood loss in Double group was more than that in Single group [(146 ±73) ml vs. (95 ±58) ml, P ＜0.01]. The mean time of hospital stay in Single group was similar to that in Double group [( 11.0 ± 3.2 ) d vs. ( 10. 9 ± 3. 3 ) d,P ＞ 0. 05]. Both groups could keep the disk space heights till the last follow-up [(7.7 ± 1.8 ) mm vs.(8. 5 ± 1.7 ) mm]. In the 6 months follow-up post operation, the VAS score decreased from (8. 1 ± 1.8) to (2.0 ± 1.0) in Single group, and (8. 1 ± 1.9) to (2. 1 ± 1. 0) in Double group. At the last follow-up, the ODI decreased from (36 ±7)% to (10 ±4)% in Single group and (37 ±6)% to (9 ±4)% in Double group, but there was no significant difference between the two groups ( P ＞ 0. 05 ). All the cases achieved fusion at the last follow-up, 3 patients in Single group and 2 patients in Double group suffered from intractable low back pain. One of the fins broke in one patient without any uncomfortable feeling. Conclusions Compared with the management of lumbar intervertebral disc protrusion accompanying degenerative instability by double B-Twin expandable spinal spacer with microendoscopic discectomy, the single B-twin can get similar clinical outcomes, but shorter surgical time, less blood loss and less medical costs.