ISObar TTL动态固定系统治疗双节段腰椎椎间盘突出症:8年随访  

ISObar TTL dynamic fixation system in the treatment of double-segment lumbar disc herniation:8-year follow-up

作　　者：曹宗锐[1] 郑博 屈波 蒋涛[1] 屈晓龙 陈天逸 张秀莉 Cao Zongrui;Zheng Bo;Qu Bo;Jiang Tao;Qu Xiaolong;Chen Tianyi;Zhang Xiuli(Department of Orthopedics,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,Sichuan Province,China)

机构地区：[1]成都医学院第一附属医院骨科

出　　处：《中国组织工程研究》2019年第32期5110-5116,共7页Chinese Journal of Tissue Engineering Research

基　　金：四川省教育厅基金项目(15AZ0265),课题名称:老年男性髋部骨折患者血清睾酮水平与骨质疏松、骨折风险的相关性,项目负责人:蒋涛;四川省卫生和计划生育委员会科研课题(18PJ473),课题名称:白藜芦醇通过调控Sirt1/PPARg通路抑制大鼠破骨细胞生成的作用及机制研究,项目负责人:屈波~~

摘　　要：背景:双节段椎间盘突出症合并腰椎不稳的患者需要对严重退变节段行坚强固定和融合,但相邻节段会出现运动位移和屈伸角度的过度性增大,出现相邻节段的退变加速,椎体不稳加重,关节突增生、椎间盘突出等情况长期困扰着临床医生及患者。目的:对比观察ISObar TTL动态固定系统与坚强钉棒固定系统治疗双节段腰椎椎间盘突出合并腰椎不稳的疗效。方法:纳入130例双节段腰椎椎间盘突出合并腰椎不稳患者,其中L3/4-L4/5患者72例,L4/5-L5/S1患者58例。对退变严重的节段行椎板减压后外侧植骨融合,对退变较轻的节段随机采取ISObar TTL动态固定(68例,设为试验组)和坚强钉棒固定系统(62例,设为对照组)。2组患者对治疗方案均知情同意,且得到医院伦理委员会批准。以死亡终点,至少随访8年,术前及术后1周、4年、8年分别使用改良Pfirrmann分级系统评估椎间盘退变情况,使用目测类比评分系统评估腰腿疼痛改善情况。结果与结论:(1)与术前相比,试验组与对照组患者术后1周、4年、8年的腰痛及腿痛目测类比评分均明显改善(P<0.05)。组间对比,2组术前及术后1周腰痛及腿痛目测类比评分差异无显著性意义(P>0.05);但是术后4,8年试验组腰痛及腿痛测类比评分明显低于对照组(P<0.05);(2)与术前相比,试验组与对照组患者术后1周、4年、8年的融合节段椎间盘退变改良Pfirrmann分级评分无明显变化(P>0.05);组间对比,2组术前及术后1周、4年、8年融合节段椎间盘退变改良Pfirrmann分级评分差异无显著性意义(P>0.05);(3)与术前相比,试验组与对照组患者术后1周、4年、8年的邻近节段椎间盘退变改良Pfirrmann评分均明显改善(P<0.05)。组间对比,2组术前及术后1周邻近节段椎间盘退变改良Pfirrmann评分差异无显著性意义(P>0.05);术后4,8年,试验组邻近节段椎间盘退变改良Pfirrmann评分均显著低于对照组(P<0.05);(4)BACKGROUND:In patients with double-segment disc herniation complicated with lumbar instability,we need to strengthen and fuse the severely degenerative segments,but the adjacent segments will have excessive movement displacement and flexion and extension angles.The degeneration of adjacent segments will accelerate.The instability of the vertebral body will be aggravated.The hyperplasia of the articular processes and the herniated discs will always plague clinicians and patients.OBJECTIVE:To observe the efficacy of the ISObar TTL dynamic fixation system versus rigid nail system in the treatment of double-segment lumbar disc herniation and lumbar instability.METHODS:130 cases of double-segment lumbar disc herniation and lumbar instability were analyzed,including 72 cases of L3/4-L4/5 and 58 cases of L4/5-L5/S1.The laminae decompression and posterior bone graft fusion were performed for severely degenerative segment.For lightly degenerative segments,ISObar TTL dynamic fixation(68 cases;trial group)and traditional nail fixation(62 cases;control group)were performed.Two groups of patients signed the informed consent.This study was approved by the Hospital Ethics Committee.End of death.The patients were followed up for at least 8 years.Disc degeneration was assessed using the modified Pfirrmann eight-level grading system preoperatively,1 week,4 years,and 8 years postoperatively.Visual Analogue Scale was utilized to assess the improvement in waist and leg pain.RESULTS AND CONCLUSION:(1)Compared with preoperatively,waist and leg pain and Visual Analogue Scale scores were significantly improved 1 week,4 years,and 8 years postoperatively in the trial and control groups(P<0.05).No significant difference in waist and leg pain and Visual Analogue Scale scores was determined preoperatively and 1 week postoperatively in both groups(P>0.05).Waist and leg pain and Visual Analogue Scale scores were significantly lower in the trial group than in the control group 4 and 8 years postoperatively(P<0.05).(2)Compared with preoperatively

关 键 词：腰椎 椎间盘突出 腰椎不稳 动态固定系统 后外侧植骨 ISOBAR TTL连接棒 坚强钉棒固定 内固定 

分 类 号：R459.9[医药卫生—治疗学] R687.3[医药卫生—临床医学]