CAJ | 학술논문

目的：对比弹性固定术和坚强固定术治疗两节腰椎间盘突出症疗效及对上节段椎体间隙退变的影响。方法2012年1月－2013年1月，收集64例两节腰椎椎间盘突出症，按手术方法不同分两组，观察组用弹性棒非融合固定术34例，对照组用椎间椎弓根钉棒系统坚强固定术30例。采用疼痛视觉模拟评分法（ visual analog scale，VAS）评价临床疗效，并通过X线片测量腰椎各间隙高度，评估生物力学改变。结果所有病例均随访，随访15～36个月，平均26．4月，两组术后2年末次随访时VAS评分较术前都明显降低，差异有统计学意义（ P＜0.05）。两组术后1周时VAS 评分差异无统计学意义（ P＞0.05）。术后2年末次随访时，观察组的上节段椎体间隙高度与术前比较减少不显著，差异不具有统计学意义（ P＞0.05）；对照组的上节段椎体间隙高度与术前比较减少明显，差异具有统计学意义（ P＜0.05）。结论坚强固定和弹性固定治疗腰椎间盘突出症都取得较好临床疗效，弹性固定术对降低相邻节段退变的发生具有优势。
목적：대비탄성고정술화견강고정술치료량절요추간반돌출증료효급대상절단추체간극퇴변적영향。방법2012년1월－2013년1월，수집64례량절요추추간반돌출증，안수술방법불동분량조，관찰조용탄성봉비융합고정술34례，대조조용추간추궁근정봉계통견강고정술30례。채용동통시각모의평분법（ visual analog scale，VAS）평개림상료효，병통과X선편측량요추각간극고도，평고생물역학개변。결과소유병례균수방，수방15～36개월，평균26．4월，량조술후2년말차수방시VAS평분교술전도명현강저，차이유통계학의의（ P＜0.05）。량조술후1주시VAS 평분차이무통계학의의（ P＞0.05）。술후2년말차수방시，관찰조적상절단추체간극고도여술전비교감소불현저，차이불구유통계학의의（ P＞0.05）；대조조적상절단추체간극고도여술전비교감소명현，차이구유통계학의의（ P＜0.05）。결론견강고정화탄성고정치료요추간반돌출증도취득교호림상료효，탄성고정술대강저상린절단퇴변적발생구유우세。
Objective To compare the treatment effects posterior two segment lumbar spinal disease , between flexible trans-pedicle fixation system and traditional rigid fixation system, to evaluate clinical efficacy and their influence on adjacent segments. Methods From Jan 2012 to Jan 2013, a total of 64 cases of lumbar disc herniation( LDH) were treated.The consents form the pa-tients were obtained.34 patients undergoing flexible transpedicle fixation system were classified as study group and 30 patients undergo-ing conventional fusion was used as controls.The clinical effect was evaluated by visual analogue scale (visual analog scale, VAS). The intervertebral height was measured by X-ray film.The biomechanicalchanges in vivo were evaluated.Results All patients were followed up for 15-36 months (mean, 26.4 months).The VAS score was significantly decreased compared with preoperative last fol-low-up (P<0.05).No significant difference of VAS score was found in two groups in early stage (P>0.05).In flexible transpedicle fixation system group, there was no statistical difference in the intervertebral height of the adjacent segment between the last follow up postoperation and preoperative (P>0.05).In traditional rigid fixation system group,the difference was significant (P<0.05).Flexi-ble fixed disc height to maintain more strong than fixation group.Conclusion Both exible transpedicle and traditional rigid fixation system have satisfying effects in treatment of degenerative lumbar spinal disorder.Flexible fixed segment degenerationin reducing the incidence of adjacent advantage.