中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
17期
25-27
,共3页
腰椎%脊柱融合术%邻近节段退变
腰椎%脊柱融閤術%鄰近節段退變
요추%척주융합술%린근절단퇴변
Lumbar vertebrae%Spinal fusion%Adjacent segment degeneration
目的 探讨腰椎单节段退变性疾病的有效治疗措施.方法 96例腰椎单节段退变性疾病患者按临床前瞻性研究的平行分组、随机对照原则,中心系统电脑将患者随机分为行腰椎后路减压椎间融合椎弓根钉棒内固定加椎间融合术治疗的融合组和行腰椎后路减压后Coflex动态固定的非融合术治疗的非融合组,每组48例.术前、术后3个月及术后2年采用疼痛视觉模拟量表(VAS)评分及腰椎功能障碍指数(ODI)进行临床疗效比较,并通过X线片测量关节活动度.结果 两组术前、术后3个月、术后2年VAS评分、ODI比较差异无统计学意义(P＞0.05).非融合组术后3个月L3～4、L4～5、L5～S1的关节活动度分别为(7.1±0.8)°、(6.1±0.8)°、(9.2±0.8)°,均高于术前的(6.4±0.8)°、(5.3±1.8)°、(7.3±0.8)°,差异有统计学意义(P＜0.05),术后2年未见明显增加.融合组术后3个月L3～4的关节活动度为(8.O±0.7)°,高于术前的(6.1±0.6)°,差异有统计学意义(P＜0.05)；术后2年为(9.1±0.5)°,较术后3个月明显升高,差异有统计学意义(P＜ 0.05);L4～5节段术后活动丧失；术后3个月L5～S1的关节活动度为(9.0±0.6)°,高于术前的(7.1±0.7)°,差异有统计学意义(P＜0.05),术后2年未见明显增加.融合组术后2年L3～4的关节活动度较非融合组显著增加,差异有统计学意义(P＜0.05).结论 融合与非融合固定术治疗腰椎单节段退变性疾病均可取得满意疗效,非融合术对腰椎节段关节活动度影响小,可能会降低相邻节段退变的发生.
目的 探討腰椎單節段退變性疾病的有效治療措施.方法 96例腰椎單節段退變性疾病患者按臨床前瞻性研究的平行分組、隨機對照原則,中心繫統電腦將患者隨機分為行腰椎後路減壓椎間融閤椎弓根釘棒內固定加椎間融閤術治療的融閤組和行腰椎後路減壓後Coflex動態固定的非融閤術治療的非融閤組,每組48例.術前、術後3箇月及術後2年採用疼痛視覺模擬量錶(VAS)評分及腰椎功能障礙指數(ODI)進行臨床療效比較,併通過X線片測量關節活動度.結果 兩組術前、術後3箇月、術後2年VAS評分、ODI比較差異無統計學意義(P＞0.05).非融閤組術後3箇月L3～4、L4～5、L5～S1的關節活動度分彆為(7.1±0.8)°、(6.1±0.8)°、(9.2±0.8)°,均高于術前的(6.4±0.8)°、(5.3±1.8)°、(7.3±0.8)°,差異有統計學意義(P＜0.05),術後2年未見明顯增加.融閤組術後3箇月L3～4的關節活動度為(8.O±0.7)°,高于術前的(6.1±0.6)°,差異有統計學意義(P＜0.05)；術後2年為(9.1±0.5)°,較術後3箇月明顯升高,差異有統計學意義(P＜ 0.05);L4～5節段術後活動喪失；術後3箇月L5～S1的關節活動度為(9.0±0.6)°,高于術前的(7.1±0.7)°,差異有統計學意義(P＜0.05),術後2年未見明顯增加.融閤組術後2年L3～4的關節活動度較非融閤組顯著增加,差異有統計學意義(P＜0.05).結論 融閤與非融閤固定術治療腰椎單節段退變性疾病均可取得滿意療效,非融閤術對腰椎節段關節活動度影響小,可能會降低相鄰節段退變的髮生.
목적 탐토요추단절단퇴변성질병적유효치료조시.방법 96례요추단절단퇴변성질병환자안림상전첨성연구적평행분조、수궤대조원칙,중심계통전뇌장환자수궤분위행요추후로감압추간융합추궁근정봉내고정가추간융합술치료적융합조화행요추후로감압후Coflex동태고정적비융합술치료적비융합조,매조48례.술전、술후3개월급술후2년채용동통시각모의량표(VAS)평분급요추공능장애지수(ODI)진행림상료효비교,병통과X선편측량관절활동도.결과 량조술전、술후3개월、술후2년VAS평분、ODI비교차이무통계학의의(P＞0.05).비융합조술후3개월L3～4、L4～5、L5～S1적관절활동도분별위(7.1±0.8)°、(6.1±0.8)°、(9.2±0.8)°,균고우술전적(6.4±0.8)°、(5.3±1.8)°、(7.3±0.8)°,차이유통계학의의(P＜0.05),술후2년미견명현증가.융합조술후3개월L3～4적관절활동도위(8.O±0.7)°,고우술전적(6.1±0.6)°,차이유통계학의의(P＜0.05)；술후2년위(9.1±0.5)°,교술후3개월명현승고,차이유통계학의의(P＜ 0.05);L4～5절단술후활동상실；술후3개월L5～S1적관절활동도위(9.0±0.6)°,고우술전적(7.1±0.7)°,차이유통계학의의(P＜0.05),술후2년미견명현증가.융합조술후2년L3～4적관절활동도교비융합조현저증가,차이유통계학의의(P＜0.05).결론 융합여비융합고정술치료요추단절단퇴변성질병균가취득만의료효,비융합술대요추절단관절활동도영향소,가능회강저상린절단퇴변적발생.
Objective To explore the treatment effects of single segmental lumbar degenerative disease.Methods Ninety-six cases of single segmental lumbar degenerative disease according to clinical prospective study group,the principle of randomized,controlled,parallel computer center system were randomly divided into lines of lumbar posterior decompression and intervertebral fusion with pedicle screw rod fixation and intervertebral fusion treatment group (fusion group) and the lumbar fusion followed by posterior decompression after Coflex dynamic fixed fusion not fusion treatment group (non-fusion group) and 48 cases in each group.Followed up for 2 years.The clinical effect was evaluated by visual analog pain score (VAS) and lumbar dysfunction index (ODI).Range of motion was measured by X-ray film.Results The VAS scores and ODI before operation and 3 months,2 years after operation had no significant difference in two groups (P ＞ 0.05).Range of motion at L3-4,L4-5,L5-S1 at 3 months after operation in non-fusion group (7.1 ± 0.8)°,(6.1 ± 0.8)°,(9.2 ± 0.8)° were higher than those before operation(6.4 ± 0.8)°,(5.3 ± 1.8)°,(7.3 ± 0.8)° (P ＜ 0.05).There was no significant difference at 2 years after operation.Range of motion at L3-4at 3 months after operation in fusion group (8.0 ± 0.7)° was higher than that before operation (6.1 ± 0.6)°(P ＜ 0.05).At 2 years after operation (9.1 ± 0.5)° was higher than 3 months after operation and non-fusion group (P ＜ 0.05).Range of motion at L4-5 was lost.Range of motion at L5-S1 at 3 months after operation in fusion group (9.0 ± 0.6)° was higher than that before operation (7.1 ± 0.7) ° (P ＜ 0.05).Conclusions Fusion and non-fusion fixation have satisfying effects in treatment of single segmental lumbar degenerative disease.Non-fusion fixation has less influence on lumbar segments and could reduce adjacent segment degeneration.
