Isobar TTL系统治疗腰椎退行性疾病的中长期随访结果  

Over two-year results of Isobar TTL fixation system for the treatment of lumbar degenerative disease

作　　者：姚欣强 蒋晖[1] 程勇泉[1] 江建明[1] 瞿东滨[1] 陈建庭[1] YAO Xin-qiang JIANG Hui CHENG Yong-quan et al(Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou , Guangdong 510515, China)

机构地区：[1]南方医科大学南方医院脊柱骨科,广州市510515

出　　处：《中国矫形外科杂志》2017年第3期199-203,共5页Orthopedic Journal of China

摘　　要：[目的]探讨Isobar TTL内固定系统治疗腰椎退行性疾病的中长期疗效。[方法]回顾性分析因腰椎退行性疾病采用Isobar TTL内固定系统治疗并有2年以上随访的20例患者资料。男11例,女9例;平均年龄43.8岁(26~61岁)。临床疗效采用疼痛视觉模拟评分(visual analog scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)进行评估。在X线片上分析动态固定节段及其上相邻节段的椎间隙高度、椎间活动度及腰椎前凸角,采用UCLA(University of California at Los Angeles Grading Scale,UCLA)系统评估椎间盘退变情况。在MRI上采用改良Pfirrmmann分级系统评估椎间盘退变情况。[结果]平均随访时间为51.9个月(26~87个月)。所有患者末次随访时VAS评分和ODI评分均较术前明显改善(P<0.05),未出现因邻近节段退变性疾病而需要手术的患者。末次随访时动态固定节段的椎间隙高度及椎间活动度较术前减少,差异有统计学意义(P<0.05),而椎间盘UCLA评分与术前比较差异无统计学意义(P>0.05)。上相邻节段的椎间隙高度、椎间活动度、椎间盘UCLA评分及腰椎前凸角与术前比较差异均无统计学意义(P>0.05)。16例患者末次随访时接受腰椎MRI检查,结果提示动态固定节段及上相邻节段的椎间盘改良Pfirrmmann分级与术前比较差异均无统计学意义(P>0.05),但其中2例出现邻近节段退变加重。3.2%(4/124)的螺钉出现松动,无内固定断裂、感染等并发症。[结论]Isobar TTL内固定系统治疗腰椎退行性疾病的临床疗效满意,但不能避免动态固定节段出现退变加重。[Objective] To evaluate the medium- to long-term outcomes of Isobar TTL fixation system for treatment of lumbar degenerative pathologies. [Methods] Twenty patients, including 11 males and 9 females with an average age of 43.8 years, who underwent Isobar TTL stabilization for lumbar degenerative diseases and were followed up more than 24 months, were retrospectively reviewed. Visual analog scale （VAS） and Oswestry disability index （ODI） were used for assessment of clinical outcomes, additionally disc height ratio, range of motion, lumbar lordosis and University of California at Los Angeles Grading Scale （UCLA） on X-ray film, as well as modified Pfirrmmann grading system on MRI was evaluated for status of disc degeneration. [Results] The patients were followed up from 26 months to 87 months with an average of 51.9 months. All of them showed significant improvements in VAS and ODI after surgery { P 〈 0.05 ） . None of them required reoperation for reason of adjacent segment degeneration. At the latest follow-up, a significant decrease of disc height ratio and range of motion was noted at the dynamic fixation level （P 〈 0.05） , however, no significant difference in UCLA was observed compared with those before surgery （P 〉 0.05 ） . In addition, at the superior adjacent segment, no significant differences was found in the disc height ratio, range of motion, UCLA and lumbar lordosis compared data before operation with the latest follow-up （P 〉 0.05 ） . Sixteen patients who accepted repeat MRI at the final follow-up had no significant difference in modified Pfirrmmann grading compared to that preoperatively （P 〉 0.05）, despite two of them showed accelerated degeneration of adjacent segment. Of 124 screws, 4 （3.2%） proved radiographic loosening, but no device breakage or infection was identified. [ Conclusion] The Isobar TTL fixation system showed good clinical outcomes, but cannot eliminate the potential of accelerated degeneration.

关 键 词：腰椎 退行性疾病 动态固定 相邻节段退变 

分 类 号：R681.53[医药卫生—骨科学]