中外医疗
中外醫療
중외의료
CHINA FOREIGN MEDICAL TREATMENT
2015年
22期
81-83,86
,共4页
腰椎退行性疾病%融合固定%非融合固定
腰椎退行性疾病%融閤固定%非融閤固定
요추퇴행성질병%융합고정%비융합고정
Lumbar degenerative disease%Fusion and fixation%Non fusion fixation
目的：对比经椎弓根非融合固定与融合固定治疗腰椎退行性疾病的临床疗效。方法选用该院自2011年1月-2014年1月采用经椎弓根非融合固定与融合固定治疗腰椎退行性疾病共190例，随机分组为非融合固定组及融合固定组，非融合固定组共90例，所用椎间弹性固定系统包括ISOBAR TTL Semi-rigid动的态固定系统、Dynesys动态稳定系统，术中进行弹性固定。融合固定组100例，均使用椎弓根螺钉及椎间融合器术中进行坚强固定。进行回顾性研究，门诊随访，对所有患者分别进行术前、术后腰骶椎活动度及影像学指标分析，及术后、术后6月、1年及1年以上10分制目测模拟评分法(VAS)评分对比。结果前者无一例出现临近节段退变，发生钉棒断裂1例(1.1%)；后者发生临近节段退变6例(6%)，融合器退出及钉棒断裂4例(4%)，P<0.01，两者之间差异有统计学意义。两组术后腰椎活动度及腰椎曲度、骨盆入射指数均差异有统计学意义(P<0.01)，即非融合固定组较融合固定更有助于改善患者脊柱-骨盆的平衡关系。两种固定方式术后3月内对患者腰腿痛症状改善无差异，但随着固定时间的延长，融合固定组疼痛逐渐加重，明显高于非融合固定组(P<0.01)。结论非融合固定在近期内可有效的防止邻近节段椎体的退变，并可较好改善患者腰腿痛症状。
目的：對比經椎弓根非融閤固定與融閤固定治療腰椎退行性疾病的臨床療效。方法選用該院自2011年1月-2014年1月採用經椎弓根非融閤固定與融閤固定治療腰椎退行性疾病共190例，隨機分組為非融閤固定組及融閤固定組，非融閤固定組共90例，所用椎間彈性固定繫統包括ISOBAR TTL Semi-rigid動的態固定繫統、Dynesys動態穩定繫統，術中進行彈性固定。融閤固定組100例，均使用椎弓根螺釘及椎間融閤器術中進行堅彊固定。進行迴顧性研究，門診隨訪，對所有患者分彆進行術前、術後腰骶椎活動度及影像學指標分析，及術後、術後6月、1年及1年以上10分製目測模擬評分法(VAS)評分對比。結果前者無一例齣現臨近節段退變，髮生釘棒斷裂1例(1.1%)；後者髮生臨近節段退變6例(6%)，融閤器退齣及釘棒斷裂4例(4%)，P<0.01，兩者之間差異有統計學意義。兩組術後腰椎活動度及腰椎麯度、骨盆入射指數均差異有統計學意義(P<0.01)，即非融閤固定組較融閤固定更有助于改善患者脊柱-骨盆的平衡關繫。兩種固定方式術後3月內對患者腰腿痛癥狀改善無差異，但隨著固定時間的延長，融閤固定組疼痛逐漸加重，明顯高于非融閤固定組(P<0.01)。結論非融閤固定在近期內可有效的防止鄰近節段椎體的退變，併可較好改善患者腰腿痛癥狀。
목적：대비경추궁근비융합고정여융합고정치료요추퇴행성질병적림상료효。방법선용해원자2011년1월-2014년1월채용경추궁근비융합고정여융합고정치료요추퇴행성질병공190례，수궤분조위비융합고정조급융합고정조，비융합고정조공90례，소용추간탄성고정계통포괄ISOBAR TTL Semi-rigid동적태고정계통、Dynesys동태은정계통，술중진행탄성고정。융합고정조100례，균사용추궁근라정급추간융합기술중진행견강고정。진행회고성연구，문진수방，대소유환자분별진행술전、술후요저추활동도급영상학지표분석，급술후、술후6월、1년급1년이상10분제목측모의평분법(VAS)평분대비。결과전자무일례출현림근절단퇴변，발생정봉단렬1례(1.1%)；후자발생림근절단퇴변6례(6%)，융합기퇴출급정봉단렬4례(4%)，P<0.01，량자지간차이유통계학의의。량조술후요추활동도급요추곡도、골분입사지수균차이유통계학의의(P<0.01)，즉비융합고정조교융합고정경유조우개선환자척주-골분적평형관계。량충고정방식술후3월내대환자요퇴통증상개선무차이，단수착고정시간적연장，융합고정조동통축점가중，명현고우비융합고정조(P<0.01)。결론비융합고정재근기내가유효적방지린근절단추체적퇴변，병가교호개선환자요퇴통증상。
Objective To compare the effect between transpedicle elastic fixation and fusion surgery in treatment of lumbar degen-erative diseases. Methods 190 patients who underwent transpedicle elastic fixation and fusion surgery in our department during January 2011 and January 2014 were divided randomly into non-fusion group (n=90) in which ISOBAR dynamic stabilization sys-tem and Dynesys dynamic neutralization system were used for elastic fixation, and fusion-group in which pedicle screw and cage were used for rigid fixation. The range of motion and imaging characteristics of lumbosacral vertebrae of all the patients before and after operation were retrospectively analyzed, and follow-up were done for the comparison of visual analogue scales after operation, 6 months, 1 year, 1 year above after operation between the two groups. Results No adjacent segment degeneration but 1 case of screw or rod fracture was found in the non-fusion group, while there were 6 cases(6%) of adjacent segment degeneration, 4 cases(4%)of fusion cage withdrawal and screw or rod fracture, and the difference was statistically significant between the two groups,P<0.01. In addition, there were statistically significant differences in range of motion of lumbosacral vertebrae, lumbar curvature, pelvic incidence between the two groups, in other words, transpedicle elastic fixation was better than fusion surgery in improving the spine-pelvis sagittal balance. Within 3 months, there was no difference in improvement of low back pain between the two groups, but with the gradual increasing of the low back pain in the fusion-group after 3 months, there was statistically significant difference between the two groups,P<0.01. Conclusion Transpedicle elastic fixation, in a short term, can prevent adjacent segment degeneration and improve the low back pain.
