摘要
目的对比评价单节段腰椎融合辅以邻近节段Isobar动态固定(邻近节段保护)与单节段椎间融合两种方式治疗腰椎退行性疾病的早期疗效及对邻近节段运动功能的影响,探讨采用Isobar动态固定进行邻近节段保护的应用价值。方法回顾性分析2008年10月至2011年1月椎间融合辅以邻近节段Isobar动态固定及单节段椎间融合内固定术的57例患者资料。邻近节段保护组27例患者术前邻近节段退变较重,行单节段融合辅以邻近节段Isobar动态固定;单节段融合组30例患者术前邻近节段无不稳或退变较轻,行单节段椎间融合内固定术。对比评价两组腰腿痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、腰椎总活动度及邻近节段活动度(range of motion,ROM)、保护节段及邻近节段退变(adjacent segment degeneration,ASDeg)发生率。结果随访时间12～40个月。两组患者术后VAS及ODI评分均获得显著改善,且两组间差异无统计学意义(P>0.05)。末次随访时两组间腰椎总活动度差异无统计学意义(P>0.05)。邻近节段保护组保护节段末次随访时椎间隙高度与术前无差异。两组术后头侧第一邻近节段活动度均显著增加。至末次随访时,邻近节段保护组保护节段退变均未见进展,邻近节段保护组7例、单节段融合组5例出现邻近节段不稳,两组之间差异无统计学意义(P=0.30)。邻近节段保护组出现螺钉松动及断裂各1例。结论腰椎融合辅以邻近节段动态固定治疗腰椎退行性疾病具有良好的早期疗效,其远期疗效有待长期随访观察。该技术存在动态固定失效的风险,其发生可能与操作技术及适应证选择有关,故应严格掌握其手术适应证,以术前邻近节段存在明显退变或不稳且无骨质疏松症的患者为宜。
Objective To evaluate the clinical value of hybrid dynamic stabilization with posterior spinal fusion （a topping-off surgery） in treatment of lumbar degenerative diseases by comparing with that of single-level fusion. Methods Twenty-seven patients with preoperative adjacent segment degeneration were giv- en hybrid dynamic stabilization with posterior spinal fusion （topping-off surgery, TOS group） , and 30 patients without preoperative adjacent segment degeneration were given single-level fusion （SLF group ）. The clinical efficacy was evaluated and compared by visual analogue scale （VAS）, Oswestry disability index （ODI）, range of motion （ROM） of global lumbar spine, ROM of adjacent segments, intervertebral space ratio （ISR）, ROM of index level （ the level dynamically stabilized by Isobar） , and the incidence of adjacent segment degeneration （ASDeg）. Results All the patients were followed up for 12 -40 months. VAS and ODI score were signifi- cantly improved in both two groups, but the difference between the two groups was not significant. The ROM of global lumbar spine was not significantly different between the two groups at the last follow-up. The ISR of index level was not significantly different before operation and at the last follow-up. The ROM of first cranial adjacent segment increased significantly at the last follow-up in both two groups. No progression of degeneration was observed in the index levels during the follow-up. Adjacent segment instability was observed in 7 patients of the TOS group and 5 patients of the SLF group, the incidence of adjacent segment instability was no significantdifference between the two groups. Looseness or breakage of fixation system was observed in two patients of the TOS group. Conclusion Hybrid dynamic stabilization with posterior spinal fusion achieves satisfying clinical efficacy during early follow-up, but the incidence of fixation system failure may be higher than the single-level fusion, suggesting selection of appropriate indications is important for achieving good clinical efficacy.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2013年第12期1288-1293,共6页
Journal of Third Military Medical University
关键词
动态固定
邻近节段保护
腰椎融合
邻近节段退变
椎间盘退变
dynamic stabilization
topping-off
lumbar fusion
adjacent segment degeneration
inter-verbral disc degeneration
