髓核摘除联合Isobar动态固定系统治疗单节段腰椎间盘突出症伴节段性不稳  

Long term curative effect of nucleus pulposus resection combined with Isobar semi dynamic fixation system for single segment LDH with segmental instability

作　　者：彭小勇 李挺 丁立林 徐庆刚[2] PENG Xiao-yong(Department of orthopedics,People＇s Hospital of Nancheng,Nanchang 344700,China)

机构地区：[1]南城县人民医院骨科,江西南城344700 [2]江西中医药大学附属医院外五科,江西南昌330004

出　　处：《牡丹江医学院学报》2018年第3期39-42,共4页Journal of Mudanjiang Medical University

摘　　要：目的评价髓核摘除联合Isobar动态固定系统治疗单节段腰椎间盘突出症(lumbar disc herniation,LDH)伴节段性不稳的远期疗效。方法选入2010年1月至2012年1月我院收治的单节段LDH伴节段不稳患者46例,随机分为对照组(n=23)和观察组(n=23)。对照组行单纯髓核摘除术治疗,观察组行单纯髓核摘除术联合Isobar半限制性动态固定系统治疗。分别采用视觉模拟评分法(visual analogue scales,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、改良Mac Nab标准评价患者疼痛、腰椎功能情况和治疗效果。术后随访3~5a,比较两组患者术前、术后3个月和末次随访VAS评分、ODI评分、固定节段活动度(range of motion,ROM)和临床疗效。结果观察组患者在术后3个月及术后末次随访时的VAS评分、ODI及ROM均明显低于对照组(P<0.05)。观察组术后5a Mac Nab优良率显著高于对照组(P<0.05)。结论单纯髓核摘除联合Isobar半限制性动态固定系统可有效改善单节段LDH伴节段不稳的临床症状,同时实现固定节段的稳定,且保留节段运动功能,远期疗效可靠。Objective To evaluate the long-term efficacy of nucleus pulposus resection combined with Isobar fixation system in the treatment of single segment LDH with segmental instability. Methods 46 cases of patients with single segment LDH with segmental instability in January 2010 to January 2012 were randomly divided into control group（ n = 23） and observation group（ n = 23）. The control group was treated with simple nucleus pulposus resection,the observation group was treated by simple nucleus pulposus resection combined with Isobar semi limited dynamic fixation system. The pain,lumbar function and treatment effect were evaluated by using the visual analogue scale（ visual analogue scales,VAS）,Oswestry disability index（ Oswestry disability index,ODI）,modified Mac Nab standard. All patients were followed up for 3 ~ 5 years. The VAS score,ODI score,（ range of motion,ROM） and clinical efficacy of two groups before and after operation were compared between the two groups before and at 3 months and 5 years after operationResults The VAS,ODI and ROM at postoperative 3 months and last follow-up of the observation group were significantly lower than those of the control group（ P 〈 0. 05）. The excellent and good rate of Mac Nab at last follow-up in the observation group was significantly higher than that in the control group（ 90. 90% vs. 63. 63%,P 〈 0. 05）. Conclusion Simple nucleus pulposus resection combined with Isobar semi restricted dynamic fixation system can effectively improve the clinical symptoms of single segment LDH with segmental instability,while achieving the fixed segment stability and retention of segmental motion function,reliable long-term curative effect.

关 键 词：单节段腰椎间盘突出症 节段性不稳 髓核摘除 Isobar动态固定 远期疗效 

分 类 号：R687.3[医药卫生—骨科学]