腰椎融合联合邻近节段K-Rod动态固定治疗腰椎退行性疾病  

Spinal fusion combined with dynamic stabilization fixation of the adjacent- segment with K-Rod system for the treatment of lumbar degenerative disease

作　　者：方明[1] 陆建猛[1] 俞武良[1] 韦勇力[1] 王兴武[1] 欧阳甲[1] 

机构地区：[1]宁波大学医学院附属医院脊柱外二科,宁波市江北区人民路247号315020

出　　处：《中国矫形外科杂志》2015年第3期215-219,共5页Orthopedic Journal of China

摘　　要：[目的]观察单节段腰椎后路椎间融合联合邻近节段K-Rod动态固定术治疗腰椎退行性疾病的临床疗效。[方法]回顾性分析2010年6月～2012年9月手术治疗的50例腰椎退行性疾病患者的临床资料,根据手术方式不同分为2组：单节段腰椎后路融合联合邻近节段K-Rod动态固定术组（A组）和单节段腰椎后路融合术组（B组）,其中A组男14例,女11例;平均年龄（41.2±5.6）岁;B组男12例,女13例;平均年龄（47.4±5.2）岁。评估两组患者的神经改善情况、腰椎总活动度、近端邻近节段活动度及椎间隙高度情况。[结果]随访时间12～25个月,平均16.7个月。无不可逆性神经症状加重、内置物失败等并发症,临床疗效满意。在末次随访时,两组患者术后VAS及ODI评分均获得显著改善（P〈0.05）;A组动态固定节段的活动度术前（8.50±0.76）°,末次随访（3.45±0.49）°,存在统计学差异（P〈0.05）;A组动态固定节段的近端临近节段的活动度术前（7.62±0.50）°,末次随访（7.87±0.62）°,无统计学差异;B组近端临近节段活动度术前（8.20±1.13）°,末次随访（8.90±1.03）°,存在统计学差异（P〈0.05）;在末次随访时,两组腰椎总活动度及椎间隙高度均无统计学差异（p〉0.05）。[结论]腰椎后路融合联合邻近节段K-Rod动态固定术治疗腰椎退行性疾病早期疗效明确,能够维持一定的脊柱生物学功能,并能避免相邻节段退变的进展,但远期疗效有待进一步观察。[Objective] To observe the effect of the implantation of K- Rod stabilization device combined with single segment spinal fusion for the treatment of lumbar degenerative disease. [Methods] We retrospectively analyzed clinical data from50 cases of patients with lumbar degenerative disease who had undergone surgical interventions between June 2010 and September2012. The patients were divided into two groups based on the surgical intervention： group A comprised 14 males and 11 females（ average age,41. 2 ± 5. 6 years） who had undergone K- Rod stabilization device combined with single segment spinal fusion,and group B comprised 12 males and 13 females（ average age,47. 4 ± 5. 2 years） who had undergone single segment spinal fusion. The neurological function improvement rate,the total activity of the lumbar spine,proximal adjacent segment range of motion（ ROM） and disc height index（ DHI） were assessed for both surgical interventions. [Results] All patients were followed up for 16. 7 months averagely,range 12- 25 months. No complications such as irreversible neurologic symptoms,implant failuresn were found,with satisfactory clinical results. At final follow- up,leg VAS,back VAS and ODI functional score were significantly improved than those of preoperation. At final＇s follow- up,two groups＇ VAS and ODI functional score were significantly improved than those of preoperation（ P〈0. 05）. The ROM at the K- Rod stabilized levels in group A was（ 8. 50 ±0. 76） ° preoperatively,（ 3. 45 ± 0. 49） ° at final＇s follow- up,there was a statistically significant difference（ P〈0. 05）. The ROM of the superior adjacent- segment in group A was（ 7. 62° ± 0. 50） ° preoperatively,（ 7. 87 ± 0. 62） ° at the end of follow- up,there was no significant difference（ P〈0. 05）. The ROM of the superior adjacent- segment in group B was（ 8. 20 ±1. 13） ° preoperatively,（ 8. 90 ± 1. 03） ° at the end of follow- up,there was a statistically significant difference（ P〈0. 05）.

关 键 词：腰椎 退行性疾病 脊柱融合术 动态固定 

分 类 号：R687.3[医药卫生—骨科学]