椎间髓核摘除辅以Isobar后路动态固定治疗腰椎间盘突出症的临床分析.doc

椎间髓核摘除辅以Isobar后路动态固定治疗腰椎间盘突出症的临床分析 王浩明，李瀚卿，施荣茂，周 强，侯天勇，刘列华 （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 评估髓核摘除辅以Isobar动态固定治疗腰椎间盘突出症的临床疗效及影像学变化。方法 回顾性分析2009年5月-2010年11月行髓核摘除辅以Isobar动态固定治疗并获得24个月以上随访资料的患者。采用疼痛视觉模拟评分（visual analogue scale，VAS）、功能障碍指数（oswestry disability index,ODI）评定临床疗效。腰椎正侧过伸过屈位片测量动态固定节段及头侧邻近节段椎间隙高度比值（intervertebral space ratio ,IVS）和椎间活动度（range of motion, ROM）和腰椎总活动度（L1～L5）的变化，采用Woodend分级评价椎间盘髓核有无信号改变。随访时间(28.45±3.59)个月。结果 术后24月VAS和ODI评分较术前均显著改善（P 0.05）。动态固定节段及邻近节段椎间隙高度比均较术前降低（P 0.05）。屈伸活动度：动态固定节段由（5.62±4.30）°降至（3.53±1.52）°（P 0.01），邻近节段和腰椎总活动度较术前均增加（P 0.05）。动态固定节段及邻近节段髓核信号与术前相比无明显改变（P0.05）。结论 髓核摘除辅以Isobar动态固定治疗腰椎间盘突出症具有满意的近期临床疗效，能维持固定节段术后椎间隙高度并保留一定的运动度，是一种可取的治疗方法。 [关键词] 腰椎间盘突出症；髓核摘除；动态内固定 [中图法分类号] [文献标志码] A Evaluation of discectomy combined with Isobar dynamic stabilization for lumbar disc protrusion Wang Haoming, Li hanqin, Shi Rongmao Zhou Qiang，Hou Tianyong ，Liu Liehua（Department of Orthopedics, the Orthopedic Surgery Center of Chinese PLA, Southwest Hospital, Third Military Medical University, Chongqing, 400038,China） [Abstract] Objective To evaluate the clinical/radiologic outcomes and effects on lumbar disc protrusion by discectomy combined with Isobar dynamic stabilization. Method Twenty-one patients underwent lumbar spine stabilization with Isobar owing to lumbar disc protrusion. Clinical outcomes were evaluated using ODI，VAS. Radiologic evaluations included whole spine AP/lateral, lumbar neutral, flexion, and extension x-ray. Follow-up period was 28.45±3.59 months. Result Clinical outcomes was significant improved between the preoperative and the post-operative 24 month (P 0.05). Intervertebral disc ratio was slightly decreased compare to preoperative in stabilized and above segments(P 0.05). ROM (range of motion) of the lumbar spine: stabilized segments were significantly decreased from 5.62±4.30 degrees to 3.53±1.52 degrees, while ROM of above segments and total lumbar spine (L1-L5)was