Topping-off技术治疗腰椎退变性疾病  

Topping-off technique for lumbar degenerative disease

作　　者：赵成[1] 徐建广[1] 连小峰[1] 李浩[1] 邱满乐[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《国际骨科学杂志》2013年第4期298-301,共4页International Journal of Orthopaedics

基　　金：上海市科委医学重点项目(09411953500)

摘　　要：目的评价Toppingoff技术治疗连续双节段腰椎退变性疾病的中期临床疗效及相关影像学改变。方法2009年10月至2012年9月，采用Topping—off技术即后路腰椎椎间融合术（PLIF）联合Coflex棘突间动态固定装置置入术治疗18例连续双节段腰椎退变性疾病患者。男6例，女12例；年龄40～63岁，平均5（）．3岁；L5～S1融合和L4～5Coflex装置置入16例，L4-5融合和L3-4。Coflex装置置入2例。按照Oswestry功能障碍指数（ODI）、疼痛视觉模拟评分（、vrAs）、日本骨科协会（JOA）腰椎功能评分评价术前及术后随访时的临床疗效，计算恢复率。经x线片检测腰椎整体活动度（L2～S1 ROM）、Coflex装置置入节段活动度（R（）M）及椎间盘高度指数（DHI），经MRI图像计算Coflex装置置入节段椎间盘髓核相对信号强度（RSI）。结果术后随访6～30个月，平均13．6个月。ODI由术前52．60±5．80降至末次随访时16．90±5．70，VAS由术前8．30±0．85降至末次随访时1．60±0．87，JOA腰椎功能评分由术前11．5±3．70提高至23．80±2．30，差异均有统计学意义（P〈0．001）。18例患者术后恢复率评定均为显效，显效率为100％。L2～Sl ROM由术前20．10°±5．30。降至末次随访时16．30°±5．20°（P〈0．05），Coflex装置置入节段ROM由术前8．80°±1．90°降至末次随访时8．20°±1．80°（P=0．19），DHI由术前0．25±0．03增加至末次随访时0．34±0．03（P〈0．001），RSI由术前0．70l±0．058改善至末次随访时0．867±0．062（P％0．01）。结论Toppingoff技术治疗连续双节段腰椎退变性疾病可取得良好的中期疗效，Coflex装置对置人节段椎间盘修复及防止其退变的作用明显。Objective To evaluate the mid term clinical effects and the imaging changes of Topping off technique for lumbar degenerative disease. Methods From October 2009 to September 2012, Topping-off technique was performed in a consecutive 18 patients with double segment lumbar degenerative disease. They included 6 males and 12 females, with an average of 50. 3 years ranging in age from 40 to 63 years. Sixteen cases were L5-s1 fusion, IA-5 Coflex dynamic interspinous stabilization device implantation. Two cases were L4 5 fusion, L3 4 Coflex implantation. Clinical outcomes were assessed by Oswestry disability index （ODI） score, visual analog score （VAS） and Japanese Orthopaedic Associstion （JOA） questionnaires before and after operation. The imaging examination was obtained to assess the range of motion of the lumbar spine （ I2 S1 ROM）, the range of motion （ROM） at the Coflex implanted levels, the disc height index （DHI） at the Coflex implanted levels, the relative signal intensity （RSI） at the Coflex implanted levels in MRI. Results The follow-up time ranged from 6 to 30 months, with an average of 13.6 months. The ODI scores decreased significantly from 52. 60 ± 5.80 preoperatively to 16.90 ± 5.70 postoperatively （P〈0. 001 ）, the VAS scores decreased significantly from 8. 30 ± 0. 85 preoperatively to 1.60 ± 0. 87 postoperatively （P〈0. 001 ）, the JOA scores were improved remarkably from 11.5 ± 3.70 preoperatively to 23.8 ± 2. 30 postoperatively （P〈0. 001 ）. The proportion with optimal effect was 100° （18 cases）. I2-S1 ROM decreased significantly from 20. 10° ± 5. 30° preoperatively to 16. 30° ± 5.20° postoperatively （P〈0. 05）, ROM was 8.20° ± 1.80° at final follow up and 8.80°± 1.90° preoperatively, there was no significant difference （P=0. 19）, DHI was improved remarkably from 0. 25 ±0. 03 preoperatively to 0. 34 ± 0. 03 postoperatively （P〈0. 001 ）, PSI was improved remarkably from 0. 701 ± 0. 058 preoperatively to 0. 867 ± 0. 062 po

关 键 词：腰椎 退行性疾病 腰椎椎间融合 非融合 动态固定 

分 类 号：R687.3[医药卫生—骨科学]