腰椎椎间融合术与动态固定术治疗腰椎退行性疾病的临床评价  

Lumbar interbody fusion vs dynamic stabilization system for degenerative lumbar disease

作　　者：马辉[1] 李忠海[1] 朱晓东[1] 白玉树[1] 王传峰[1] 吴大江[1] 陈誉[1] 李明[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《脊柱外科杂志》2011年第4期226-231,共6页Journal of Spinal Surgery

摘　　要：目的通过比较分析腰椎椎间融合术与动态固定术治疗腰椎退行性疾病的临床疗效和术后并发症,探讨腰椎退行性疾病治疗方法的合理选择。方法 2009年1月～2010年12月,选择32例腰椎退行性疾病(L4/L5)患者,按配对设计分为对照组和治疗组,对照组16例患者均行椎弓根螺钉固定并单枚融合器置入;治疗组16例患者行常规椎板切除减压、髓核摘除和Isobar动态固定。比较观察2组病例的治疗效果、手术时间、出血量、手术并发症等。治疗效果评价采用Oswestry功能障碍指数(Oswestry disability index,ODI)及疼痛视觉模拟量表(visual analogue scale,VAS)评分,手术邻近节段(L3/L4和L5/S1)及腰椎(L2～S1)的活动度(range of motion,ROM)采用过伸过屈动力侧位X线片检查进行评价。结果所有患者均获6～24个月的随访,平均15.8个月。与术前相比,2组患者术后症状均有明显改善,术后ODI及VAS评分与术前相比差异有统计学意义(P<0.01);2组手术时间、出血量差异无统计学意义(P>0.05);2组均未出现内固定相关并发症;2组术后邻近节段(L3/L4和L5/S1)的ROM与术前相比差异无统计学意义(P>0.05)。腰椎(L2～S1)的ROM,融合组较术前显著下降,差异有统计学意义(P<0.05);而动态固定组较术前有所增加,但差异无统计学意义(P﹥0.05)。结论腰椎椎间融合术与Isobar动态固定术治疗单节段腰椎退变性疾病均可取得满意的短期临床疗效,但理论上动态固定技术内固定失败的风险高于椎间融合术,故采用动态固定技术治疗腰椎退变性疾病应慎重。Objective To assess the clinical effectiveness and postoperative complications of lumbar interbody fusion and dynamic stabilization system（the Isobar system） for degenerative lumbar disease,in an attempt to explore an optimal surgical procedure.Methods From January 2009 to December 2010,32 degenerative disease（L4/L5） cases were randomly and equally assigned to an experimental group of decompression and dynamic stabilization with Isobar system（n=16） and a control group of traditional interbody fusion（n=16）.Visual analogue scale（VAS） and the Oswestry disability index（ODI） were used to assess clinical outcome preoperatively and postoperatively.The outcomes,operative time,blood loss and complications were analyzed and compared.Fexion or extension reontgenographs were taken before surgery and at the final follow-up.Range of motion（ROM） was assessed at the cranial/caudal adjacent levels（L3/L4and L5/S1） and at the lumbar spine from L2-S1.Results All cases were followed up for 15.8 months averagely,ranging from 6 to 24 months.Compared with that of preoperative,the general condition was improved,and their VAS scores and ODI were significantly reduced postoperatively during the whole period of follow-up（P0.01）.No difference was found in operation time and blood loss between the 2 groups（P〉0.05）.No complication related to internal fixation was observed.There was no significant difference in the ROM of the adjacent level ROM（L3/L4and L5/S1）before and after operation（P〉0.05）.In control group,the ROM of the lumbar spine（L2-S1） was significantly reduced postoperatively（P〈0.05）.And in experimental group the ROM of the lumbar spine（L2-S1） was increased postoperatively,but the different had no statistical significance（P〉0.05）.Conclusion Both lumbar interbody fusion and dynamic stabilization system（the Isobar system） demonstrate satisfactory outcoms in treatment of degenerative lumbar disease.However,theoretically dynamic stabilization has higher risk of fa

关 键 词：腰椎 椎间盘移位 椎管狭窄 脊柱滑脱 外科手术 

分 类 号：R681.533[医药卫生—骨科学]