腰椎退行性疾病ISOBAR动态固定早期临床观察  

Application of ISOBAR Dynamic Stabilization System in Treatment of Degenerative Lumbar Disease

作　　者：李忠海[1] 王诗媛[1] 付强[1] 马辉[1] 唐昊[1] 张秋林[1] 

机构地区：[1]上海长海医院骨科,上海市200433

出　　处：《中国骨与关节损伤杂志》2011年第11期973-976,共4页Chinese Journal of Bone and Joint Injury

基　　金：上海市科委医学重点项目(09411952900)

摘　　要：目的探讨后路ISOBAR动态稳定系统在腰椎退行性疾病治疗中的应用指征、短期疗效和安全性。方法将自2008年9月～2009年12月收治腰椎退行性疾病(L4、5)28例,随机分为常规减压加ISOBAR动态固定组(治疗组14例)和传统椎间融合内固定组(对照组14例)。结果所有患者获得6～24个月(平均14.6个月)的随访。术后随访VAS评分及ODI均得到明显改善,与术前相比均有显著性差异(P<0.001)。对照组术后L4、5及L2～S1节段的ROM均较术前明显下降(P<0.05),而相邻节段L3、4、L5S1的(活动度)ROM无显著变化(P>0.05)。治疗组术后各节段和L2～S1的ROM较术前均无明显变化(P>0.05)。结论 ISOBAR动态固定系统治疗单节段腰椎退变性疾病取得了满意的短期临床疗效,但没有充分证据证明动态固定技术可以取代传统的融合技术,手术适应证的合理选择十分重要。Objective To assess the indication, safety and efficacy of the dynamic stabilization system （the ISOBAR system） in the treatment of degenerative lumbar disease. Methods Between September 2008 and December 2009, 28 consecutive patients seeking medical treatment for one level （L4.5） lumbar degenerative disease in our department were included in this study. They were randomly and evenly assigned into an experimental group of decompression and dynamic stabilization with the ISOBAR system （n=14） and a control group of traditional interbody fusion （n=14）. Results All cases were followed up for 14.6 months averagely. The postoperative VAS and ODI showed a significant postoperative reduction of disability during the whole period of follow-up （P 〈0.001）. There was a signifcant reduction of the global ROM of the lumbar spine （Lν2Sν1） and the segmental ROM at the index level （L4.5） in the fusion group（P 〈0.05）, whereas adjacent level ROM did not change signifcantly （P 〉0.05）. In the dynamic stabilization group, no signifcant changes of global lumbar spine /ION （Lν2Sν1 and segmental ROM （index level and cranial/caudal adjacent levels） were seen （ P 〉0.05）. Conclusion This study shows that monosegmental posterior dynamic stabilization with the ISOBAR system demonstrates excellent outcome for improvement in back pain, neurogenic claudication and patient satisfaction in the short follow-up duration. At present, there is no overwhelming evidence to suggest that the system performs better than traditional fusion as far as the mid-term results are concerned. The selection of suitable surgical candidates and determination of valid indications for operative treatment are very important.

关 键 词：腰椎 退行性疾病 相邻节段病 融合 非融合 动态固定 

分 类 号：R681.57[医药卫生—骨科学]