腰椎融合辅以邻近节段动态固定与腰椎融合治疗腰椎退行性疾病早期疗效的对比观察.docVIP

腰椎融合辅以邻近节段动态固定与腰椎融合治疗腰椎退行性疾病早期疗效的对比观察 施荣茂，王浩明，陈道森，李瀚卿，邸 宁，代 飞，罗 飞，许建中，周 强 （400038 重庆，第三军医大学西南医院骨科，全军矫形外科中心） [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植骨融合内固定术的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。末次随访时两组间腰椎总活动度差异无统计学意义。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症选择有关，故应严格掌握其手术适应症，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。 [关键词] Isobar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 [中图法分类号] R687 [文献标志码] A Clinical comparative evaluation of hybrid dynamic stabilization with posterior spinal fusion versus single-level fusion in the treatment of lumbar degenerative diseases Shi Rongmao,Wang Haoming,Chen Daosen,Li Hanqing,Di Ning ,Dai Fei,Luo Fei,Xu Jianzhong,Zhou Qiang(Department of Orthopedics, the Orthopedic Surgery Center of Chinese PLA, Southwest Hospital, Third Military Medical University, Chongqing, 400038, P.R.China.) [Abstract] Objective The purpose of this study was to evaluate the value of hybrid dynamic stabilization with posterior spinal fusion (a topping-off surgery) by compared to single-level fusion. Methods 27 patients adjacent segments of fused with preoperative degeneration were performed hybrid dynamic stabilization with posterior spinal fusion (Topping-off surgery，TOS group), 30 patients adjacent segments of fused level without preoperative degeneration were performed single-level fusion(SLF group). The clinical effects were evaluated by visual