髓核摘除联合动态固定治疗单节段腰椎间盘突出症伴节段性不稳的3年随访研究  

Discectomy and Isobar placement for single-level lumbar disc herniation complicated with segmental instability, a three-year follow-up study

作　　者：包肇华[1] 杨惠林[1] 张志明[1] 季一鸣[1] 梅晣 

机构地区：[1]苏州大学附属一院骨科,苏州市215006

出　　处：《中国脊柱脊髓杂志》2014年第12期1085-1089,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：探讨单纯髓核摘除联合应用Isobar半限制性动态固定系统固定治疗单节段腰椎间盘突出症伴节段性不稳的临床效果。方法：2009年1月~2010年12月共收治32例单节段腰椎间盘突出症伴节段性不稳的腰腿痛患者,均有相应节段神经受压引起的腿痛、麻木、无力,均行保守治疗3~6个月治疗无效。责任节段分别为L3/4节段2例,L4/5节段16例,L5/S1节段14例。均在全麻下行后路腰椎间盘髓核摘除、Isobar半限制性动态固定系统固定手术。采用VAS和ODI评价临床疗效,术后3个月及末次随访行X线正侧位片、动力位片检查及CT扫描观察内固定情况和固定节段活动度。结果：所有患者均完成3年临床随访,平均手术时间70±16min,平均出血量150±42ml。术前VAS评分平均为7.3±2.2分;术后3个月时为2.2±1.0分,末次随访时为1.8±0.9分,均较术前显著减轻（P〈0.05）。ODI术前为（59.7±13.2）%;术后3个月时为（32.6±11.4）%,末次随访时为（30.8±10.6）%,较术前明显改善（P〈0.05）。责任节段术前活动度14°±2.5°,术后3个月时为2.8°±1.5°,末次随访时为2.6°±1.3°,与术前比较差异有显著性（P〈0.05）。所有患者无钉棒断裂,固定节段无再发椎间盘突出。结论：髓核摘除联合Isobar半限制性动态固定系固定治疗单节段腰椎间盘突出症伴节段性不稳能够有效缓解临床症状,同时保留了责任节段部分活动度。Objectives： To explore the clinical results of a semi-rigid dynamic fixation system（Isobar） plus discectomy for single-level lumbar disc herniation（LDH） complicated with segmental instability. Methods： Thirty-two patients between January 2009 and December 2010 suffering from back and leg pain for 2-4 years and diagnosed as single-level LDH complicated with segmental instability were included in this retrospective study, all cases presented with leg pain, numbness and weakness and showed irresponsible to conservational treatment of 3-6 months. The diseased level located at L3/4 in 2 cases, L4/5 in 16 cases and L5/S1 in 14 cases. All cases underwent discectomy and decompression and fixation with Isobar. VAS and ODI scores were used to evaluate the results. X-ray and CT scan were performed at 3 months, 6 months, 1 year, 3 years to evaluate the status of implants and ROM of surgical level. Results： All patients finished 3-year follow-up.The average operation time was 70±16min, and the average blood loss was 150±42ml. The preoperative VAS score was 7.3±2.2, and the 3-month postoperative VAS was 2.2±1.0 and remained at this level until the final follow-up（1.8±0.9, P〈0.05）. The ODI of preoperation was（59.7±13.2）%, that of 3-month follow-up was（32.6±11.4）% and was（30.8±10.6）% of 3 years（P〈0.05）. The preoperative ROM was 14°±2.5°, that of 3-month follow-up was 2.8°±1.5° and the 3-year follow-up ROM was 2.6°±1.3°（P〈0.05）. No screw breakage or disc recurrence was noticed. Conclusions： For single-level LDH complicated with segmental instability, discectomy and Isobar placement is effective in relieving the symptoms and maintaining the segmental motion.

关 键 词：腰椎间盘突出症 腰椎不稳症 ISOBAR 动态固定系统 

分 类 号：R681.5[医药卫生—骨科学]