限制性动态椎弓根钉系统治疗腰椎退行性疾病  

Restrictive dynamic pedicle screw system for treatment of lumbar degenerative disease

作　　者：徐汪洋[1] 王业杨 李贵涛[1] 张辉[1] 周晓忠[1] 罗俊男 U Wang-yang;WANG Ye-yang;LI Gui-tao;ZHANG Hui;ZHOU Xiao-zhong;LUO Jun-nan(Orthopaedic Centre,The Second Hospital of Guangdong Province,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院骨科中心

出　　处：《中国矫形外科杂志》2019年第21期1931-1935,共5页Orthopedic Journal of China

基　　金：广州市海珠区科技计划项目（编号：201304231038742045）

摘　　要：[目的]评价限制性动态椎弓根钉系统非融合固定治疗伴有腰椎不稳定疾病的临床效果。[方法]回顾性分析2013年3月~2016年3月行手术治疗的腰椎间盘突出症合并腰椎退行性变52例,其中使用限制性动态椎弓根钉非融合固定23例(非融合组),椎弓根钉和椎间植骨融合固定29例(融合组)。比较两组患者的临床资料、JOA评分和影像测量的固定与上位邻近节段椎体前后位移、椎间隙高度和腰段活动度。[结果]非融合组手术时间、手术出血量和术后下地时间均显著少于融合组(P<0.05),两组患者各有1例出现切口浅表感染,经清创后愈合。随访12~36个月,平均(15.12±2.87)个月。两组患者术后JOA评分均较术前明显增加,且非融合组效果显著优于融合组(P<0.05)。两组患者固定节段椎体椎间隙高度变化与术前相比差异无统计学意义(P>0.05);非融合组邻近上位节段椎体间隙高度与术前比较减少不明显,但融合组显著减少(P<0.05)。非融合组患者腰椎活动度显著大于融合组,差异有统计学意义(P<0.05)。两组均未发现内置物松动或断钉。[结论]限制性动态椎弓根钉非融合固定较常规椎间植骨椎弓根钉固定融合术手术时间更短、创伤更小、术后恢复更快,可减轻邻近节段退变,并保留腰椎活动度。[Objective] To evaluate the clinical outcomes of restrictive dynamic pedicle screw system for lumbar degenerative diseases(LDD) accompanied with lumbar instability. [Methods] A retrospective study was conducted on 52 patients who underwent surgical treatment for lumbar disc herniation accompanied with degenerative lumbar instability in our department from March 2013 to March 2016. Of them, 23 patents had operation performed with the restrictive dynamic pedicle screw system without fusion(the non-fusion group), while the remaining 29 patients received routine lumbar fusion with interbody cage and pedicle screw-rod system(the fusion group). The clinical data, Japanese Orthopaedic Association(JOA) score and radiographic measurements, such as vertebral anteroposterior displacement, intervertebral space height, and lumbar range of motion(ROM), were compared between the two groups. [Results] The non-fusion group consumed significantly less operation time,had less intraoperative blood loss and shorter time to ambulate postoperatively than the fusion group(P<0.05). One patient in each group got superficial wound infection, which healed after local debridement. The follow up lasted for 12 to 36 months with an average of(15.12±2.87) months. Compared with those before operation, the JOA scores in both groups significantly increased postoperatively(P<0.05). In addition, the non-fusion group was significantly superior to the fusion group in JOA scores at each time point postoperatively(P<0.05). In term of radiographic measurements, the vertebral anteroposterior displacement and intervertebral space height of the fixed segment kept no significantly changed over time(P>0.05), whereas the anteroposterior displacement of the upper adjacent segment significantly increased(P<0.05), and the space height of the upper adjacent segment significantly decreased in the fusion group as time went(P<0.05), associated with a statistically significant difference between the non-fusion and fusion groups at the latest follow up(P<0.05). Further

关 键 词：限制性动态椎弓根钉系统 非融合 腰椎不稳 腰椎退行性疾病 

分 类 号：R681.57[医药卫生—骨科学]