摘要
[目的]对比分析腰椎ISOBAR TTL半坚强动态内固定与坚强内固定治疗腰椎退行性疾病的临床疗效。[方法]分别采用Isobar TTL半坚强动态内固定及坚强内固定术(PLIF腰椎后路椎体间融合)治疗腰椎退行性病变各36例,每组平均随访时间2年以上,采用VAS(疼痛视觉模拟)评分、JOA评分以及中华医学会骨科分会脊柱外科组腰椎手术疗效标准评价临床疗效,并对比观察两组间手术时间、术中出血量、术后住院时间、住院费用以及末次随访时邻近节段退变及相关并发症。[结果]Isobar TTL组疗效总优良率91.7%,末次随访时VAS评分从术前8.3±1.0降低至1.5±1.9,JOA评分从术前4.3±2.8提高至25.2±5.6,32例患者表示如果罹患相同疾病需要手术,会选择同种手术方式;PLIF组疗效总优良率83.3%,末次随访时VAS评分从术前7.7±1.5降低至1.7±2.4,JOA评分从术前5.1±3.1提高至25.1±6.3,30例患者表示患相同疾病需要手术时,仍会选择坚强内固定融合术。Isobar TTL组中1例(2.8%)发生邻近节段退变(adjacent segment degen-eration,ASD),PLIF组中3例(8.3%)出现ASD。两组间末次随访时VAS及JOA评分差异无统计学意义。I-sobar TTL组平均住院费用(71 197±12 370)元,PLIF组平均住院费用(40 734±10 644)元,两组差异有显著统计学意义。Isobar TTL组1例出现大小便功能障碍、PLIF组1例出现椎弓根钉断裂。[结论]Isobar TTL半坚强动态内固定与坚强内固定治疗腰椎退行性疾病均可取得满意疗效,Isobar TTL半坚强动态固定对腰椎节段活动度影响小,可能会降低相邻节段退变的发生。
[Objective]To compare the clinical effects between ISOBAR TTL semi-rigid dynamic stabilization system versus rigid fixation in the treatment of degenerative lumbar disease. [Methods]Seventy-two cases were divided into Isobar TTL semi-rigid dynamic stabilization system group（Isobar TTL）and rigid fixation group（PLIF）,with 36 cases in each.Both groups were followed up for over 2 years.The clinical effects were evaluated by visual analogue scale（VAS）,JOA scoring and the spinal operative standard of Chinese Medical Association.In addition,operation time,intraoperative blood loss,hospital stay,complications and hospitalization expenses were also compared between groups.[Results]In the group of Isobar TTL,the good to excellent result was 91.7%,VAS decreased from 8.3±1.0 preoperatively to 1.5±1.9 at final follow-up,and JOA improved from 4.3±2.8 to 25.2±5.6.The averaged hospitalization expense was RMB $71 197±12 370.The 32 patients would have selected the surgery if they had the same disease.In the group of PLIF,The good to excellent result was 83.3%;VAS decreased from 7.7±1.5 to 1.7±2.4;and JOA improved from 5.1±3.1 to 25.1±6.3.The averaged hospitalization expense was RMB $ 40 734±10 644.Thirty in 36 patients would have selected the rigid fixation if they had the same disease.One case（2.8%） developed adjacent segment degeneration（ASD） in the Isobar TTL group,but 3 cases（8.3%） in the PLTT group developed ASD.One patient developed urine and stool disorder in the Isobar TTL group,and one patient had breakage of pedicle screw in the PLIF group.[Conclusion]Both Isobar TTL and PLIF have satisfactory effects in treatment of degenerative lumbar disease. Isobar TTL semi-rigid dynamic stabilization system has less influence on range of motion of lumbar segments and can reduce adjacent segment degeneration.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第5期373-377,共5页
Orthopedic Journal of China
关键词
腰椎
动态固定
退行性疾病
非融合
lumbar vertebrae
dynamic fixation
degenerative disease
non-fusion
