Isobar动态稳定系统固定联合腰椎间盘切除术治疗腰椎间盘突出症患者的近期疗效  

Short-term effect of Isobar dynamic stabilization system fixation combined with lumbar discectomy in patients with lumbar disc herniation

作　　者：刘屹林[1] 杨浩[1] 张敏[1] 阮天臣 李朋飞 熊英杰 王利民[1] 王玉强[1] Liu Yilin;Yang Hao;Zhang Min;Ruan Tianchen;Li Pengfei;Xiong Yingjie;Wang Limin;Wang Yuqiang(Department of Orthopedics,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中华医学杂志》2019年第3期188-192,共5页National Medical Journal of China

基　　金：河南省高等学校重点科研项目(19A320083).

摘　　要：目的探讨Isobar动态稳定系统固定联合腰椎间盘切除术对腰椎间盘突出症(LDH)的近期疗效。方法分析2015年6月至2017年6月郑州大学第一附属医院收治的62例腰椎间盘突出症患者的临床资料,依据手术方式的不同分为对照组和观察组,其中对照组31例患者接受单纯髓核摘除术治疗,观察组31例患者接受Isobar动态稳定系统固定联合腰椎间盘切除术治疗。比较两组术前、术后及术后6个月的腰椎Oswestry功能障碍指数(ODI)及日本骨科协会(JOA)下腰痛评分,腰椎及邻近节段活动度及退变情况,炎症因子水平[C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)],同时比较术中情况。手术前后数据比较采用t检验。结果术后及术后6个月对照组和观察组ODI评分均较术前有所下降,JOA评分均较术前有所上升(分别为25.5±3.0、27.5±3.2比15.3±2.2和18.6±2.3、23.3±2.9比15.3±2.0),且观察组ODI评分显著低于对照组,JOA评分显著高于对照组,差异均有统计学意义(t=0.04~10.19,均P<0.05)。观察组手术时间、住院时间、术中出血量及并发症发生率均显著低于对照组。术后及术后6个月观察组腰椎总活动度显著高于对照组,差异具有统计学意义(t=37.67、36.60,均P<0.05);邻近节段活动度显著低于对照组,差异具有统计学意义(t=9.28、3.79,均P<0.05);Pfirrmann分级显著低于对照组,差异具有统计学意义(t=3.11、5.05,均P<0.05)。术后及术后6个月两组CRP、IL-6及TNF-α水平均较术前有所下降,且观察组CRP、IL-6及TNF-α水平显著低于对照组,差异具有统计学意义(t=0.52~10.99,均P<0.05)。结论Isobar动态稳定系统固定联合腰椎间盘切除术可有效改善腰椎间盘突出症患者腰椎功能及腰椎活动度,降低炎症水平及复发率。Objective To investigate the short-term effect of Isobar dynamic stabilization system fixation combined with lumbar discectomy in patients with lumbar disc herniation. Methods From June 2015 to June 2017, 62 patients with lumbar disc herniation treated in the First Affiliated Hospital of Zhengzhou University were divided into control group and observation group according to the therapy. The 31 patients in the control group were treated with simple excision of nucleus pulposus and the 31 patients in the observation group were treated with Isobar dynamic stabilization system fixation combined with lumbar discectomy. The score of Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) score of low back pain, lumbar and adjacent stage activity, inflammatory factor levels[C reaction protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α)] were compared between the two groups before and after the operation and 6 months after the operation. The data were compared between the two groups with t test. Results After the operation and 6 months after, the ODI scores of the two groups decreased and the JOA scores increased significantly (25.5±3.0, 27.5±3.2 vs 15.3±2.2 and 18.6±2.3, 23.3±2.9 vs 15.3±2.0), the ODI scores of the observation group was significantly lower than those in the control group;the JOA scores were significantly higher than those in the control group (t=0.04-10.19, all P<0.05). The operative time, hospital stay, intraoperative blood lose and complications rate in the observation group were all significantly lower than those in the control group. The total activity of lumbar vertebrae in the observation group was significantly higher than that in the control group after operation and 6 months after (t=37.67, 36.60, both P<0.05);the activity of adjacent segments in the observation group was significantly lower than that of the control group (t=9.28, 3.79, both P<0.05);the Pfirrmann grade was significantly lower than that in the control group (t=3.11, 5.05, both P<0.05

关 键 词：腰椎间盘突出症 Isobar动态稳定系统 腰椎间盘切除术 近期疗效 

分 类 号：R687.3[医药卫生—骨科学]