CAJ | 학술논문

背景：椎间盘摘除椎弓根内固定融合是修复腰椎退变疾病的金标准，但在治疗疾病的同时可引出来其他并发症，如邻近节段的退行性变或加剧已存在的脊柱退行性变等问题。针对腰椎融合固定的问题，近年来腰椎弹性固定成为一个热点。 　　目的：探讨腰椎椎弓根动态内固定修复腰椎管狭窄症和腰椎间盘突出症的近期疗效。 　　方法：2010年12月至2012年12月采用腰椎动态内固定系统共治疗腰椎管狭窄症和腰椎间盘突出症患者62例。L3，4节段5例；L4，5节段20例；L5S1节段20例；L3，4，L4，5双节段6例；L4，5，L5S1双节段8例，L3，4，5S1三节段患者3例。男34例，女28例；年龄32-72岁，平均50.8岁。根据使用不同内固定系统分为3组，使用通用动态腰椎固定系统17例，K-Rod后路动态稳定系统28例，Dynesys系统17例。随访24-48个月，评价指标包括目测类比评分、Oswestry功能障碍指数、影像学分析及疗效优良率。 　　结果与结论：结果显示，与治疗前相比，治疗后6个月及末次随访时各组患者目测类比评分、Oswestry功能障碍指数均获得显著改善(P<0.01)。治疗前、末次随访时置入节段及邻近节段高度无明显变化。治疗后各组疗效优良率差异无显著性意义(P>0.05)。提示腰椎动态内固定系统是修复腰椎管狭窄症和腰椎间盘突出症的一种有效方法，3种弹性固定虽然存在结构的不同，但是早期治疗效果上无明显区别，远期效果有待进一步观察。
배경：추간반적제추궁근내고정융합시수복요추퇴변질병적금표준，단재치료질병적동시가인출래기타병발증，여린근절단적퇴행성변혹가극이존재적척주퇴행성변등문제。침대요추융합고정적문제，근년래요추탄성고정성위일개열점。 　　목적：탐토요추추궁근동태내고정수복요추관협착증화요추간반돌출증적근기료효。 　　방법：2010년12월지2012년12월채용요추동태내고정계통공치료요추관협착증화요추간반돌출증환자62례。L3，4절단5례；L4，5절단20례；L5S1절단20례；L3，4，L4，5쌍절단6례；L4，5，L5S1쌍절단8례，L3，4，5S1삼절단환자3례。남34례，녀28례；년령32-72세，평균50.8세。근거사용불동내고정계통분위3조，사용통용동태요추고정계통17례，K-Rod후로동태은정계통28례，Dynesys계통17례。수방24-48개월，평개지표포괄목측류비평분、Oswestry공능장애지수、영상학분석급료효우량솔。 　　결과여결론：결과현시，여치료전상비，치료후6개월급말차수방시각조환자목측류비평분、Oswestry공능장애지수균획득현저개선(P<0.01)。치료전、말차수방시치입절단급린근절단고도무명현변화。치료후각조료효우량솔차이무현저성의의(P>0.05)。제시요추동태내고정계통시수복요추관협착증화요추간반돌출증적일충유효방법，3충탄성고정수연존재결구적불동，단시조기치료효과상무명현구별，원기효과유대진일보관찰。
BACKGROUND:Discectomy and pedicle fixation fusion are golden standard to repair lumbar degenerative disease, but the treatment would induce other complications such as degeneration of adjacent segments or severer pre-existing spinal degeneration. For the problem of lumbar fusion and fixation, lumbar elastic fixation has recently been a hot focus. OBJECTIVE:To evaluate the short-term effectiveness of dynamic lumbar pedicle fixation in repair of lumbar spinal stenosis and lumbar disc herniation. METHODS:From December 2010 to December 2012, 62 cases of lumbar spinal stenosis and lumbar disc herniation treated with lumbar dynamic system were included. The involved segments included:5 cases at L 3/4 , 20 cases at L 4/5 , 20 cases at L 5 S 1 , 6 cases at double segment L 3/4 and L 4/5, 8 cases at double segment L 4/5 , L 5 S 1 , 3 cases at L 3/4 and L 5 S 1 . There were 34 males and 28 females with an average age of 50.8 years (range 32 to 72 years). According to different fixation systems, they were assigned to three groups:general dynamic lumbar fixation system in 17 cases, K-Rod posterior dynamic stabilization system in 28 cases, and Dynesys system in 17 cases. The fol ow-up time was from 24 to 48 months. Evaluation indexes included visual analogue scale, Oswestry disability index, imaging analysis and excellent and good rate of curative effects. RESULTS AND CONCLUSION:Compared with before treatment, visual analogue scale score and Oswestry disability index were significantly improved at 6 months after treatment and final fol ow-up (P<0.01). No apparent changes were detected in the length of inserted segments and adjacent segments before treatment and during final fol ow-up. There were no significant differences in the excellent and good rate in each group after treatment (P>0.05). These data indicated that the lumbar dynamic system was an effective option for lumbar disc herniation and spinal stenosis. Although there are some differences in the structure of three kinds of flexible fixation, no obvious difference in early therapeutic effects was detected. Long-term effects deserve further investigations.