Waveflex半刚性内固定系统治疗腰椎退变性疾病的中期疗效  

Mid-term efficacy of Waveflex semi-rigid internal fixation system in the treatment of lumbar degenerative diseases

作　　者：崔凯莹 陈文明 刘国岩[1] 于宁 侯鹏飞 张震岳 郝延科[1] Cui Kaiying;Chen Wenming;Liu Guoyan;Yu Ning;Hou Pengfei;Zhang Zhenyue;Hao Yanke(Department of Orthopaedics,the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;TheFirst Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]山东中医药大学附属医院骨科,济南250014 [2]山东中医药大学第一临床医学院,济南250355

出　　处：《中华骨科杂志》2021年第17期1257-1266,共10页Chinese Journal of Orthopaedics

基　　金：山东省重点研发计划(2018GSF119011)。

摘　　要：目的探讨Waveflex半刚性内固定系统联合后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗双节段腰椎退变性疾病的中期临床疗效及影像学变化。方法回顾性分析2014年9月至2015年9月51例行手术治疗的腰椎退变性疾病患者资料,其中男29例,女22例,年龄(65.5±5.6)岁(范围58~73岁)。术前行椎间隙退变的影像学分级加州大学洛杉矶分校(University of California at Los Angeles,UCLA)评价标准及Pfirrmann椎间盘退变分级。23例主要责任节段行减压固定融合,邻近次要责任或退变节段行Waveflex半刚性内固定(联合组);28例双节责任节段均行减压固定融合(融合组)。于摄腰椎侧位X线片测量术后及随访时的半刚性内固定节段椎间隙高度指数(disc height index,DHI)及椎间孔高度(intervertebral foramina height,IFH),头侧邻近节段椎间隙的DHI及IFH,头侧邻近节段椎体的水平位移(horizontal displacement,HD);融合组测量头侧邻近节段椎间隙的DHI及IFH,头侧邻近节段椎体的HD。并行简化McGill疼痛问卷(short-form McGill pain questionnaire,SF-MPQ)及Oswestry功能障碍指数问卷(Oswestry disability index,ODI)评估疗效。结果51例随访时间(5.4±0.3)年(范围5.2~6.3年)。联合组与融合组腰腿痛及功能较术前有明显改善,术后3个月、1年及5年末次随访时SF-MPQ及ODI与术前相比,差异均有统计学意义(P<0.05)。联合组半刚性内固定节段椎间隙高度指数术前,术后3个月、1年及5年分别为37.8%±7.6%、37.9%±7.4%、36.5%±6.9%、36.0%±7.1%,差异无统计学意义;半刚性内固定节段椎间孔高度术前,术后3个月、1年及5年分别为(21.5±2.8)、(21.4±2.8)、(20.4±2.7)、(19.4±2.4)mm,差异有统计学意义(P<0.05);半刚性内固定头侧邻近节段椎间隙高度指数术前,术后3个月、1年及5年分别为37.1%±9.3%、36.8%±9.1%、35.2%±9.1%、33.9%±8.8%,差异无统计学意义。半刚性内固定头侧邻近节段椎间孔高度术前,术Objective To investigate the mid-term clinical efficacy and imaging changes of Waveflex semi-rigid internal fixation system combined with posterior lumbar interbody fusion(PLIF)in the treatment of double segmental lumbar degenerative diseases.Methods The data of 51 patients with lumbar degenerative diseases who underwent surgery from September 2014 to September 2015 were retrospectively analyzed,including 29 males and 22 females,aged 65.5±5.6 years(range 58-73 years).Preoperative intervertebral space degeneration grade by University of California at Los Angeles(UCLA)and Pfirrmann intervertebral disc degeneration grade were recorded.23 cases of primary responsible segments were treated with decompression,fixation and fusion,and adjacent secondary responsible or degenerative segments were treated with Waveflex semi-rigid internal fixation(combined group);28 cases of double segments were treated with decompression,fixation and fusion(fusion group).Disc height index(DHI)and intervertebral foramina height(IFH)of the semi-rigid fixation segments,DHI and IFH of the upper adjacent intervertebral space,and horizontal displacement of the upper adjacent vertebral body(HD)were measured on lateral X-ray films of lumbar spine;In the fusion group,DHI and IFH adjacent to the upper vertebral space and HD adjacent to the upper vertebral body were measured.The efficacy was evaluated by short-form McGill Pain Questionnaire(SF-MPQ)and Oswestry disability index(ODI).Results 51 cases were followed up for 5.4±0.3 years(range 5.2-6.3 years).The low back and leg pain and function in the combined group and fusion group were significantly improved compared with those before operation.SF-MPQ and ODI at 3 months,1 year,5 years after operation were significantly different from those before operation(P<0.05).In the combined group,the DHI of semi-rigid internal fixation segments before operation and 3 months,1 year,5 years after operation were 37.8%±7.6%,37.9%±7.4%,36.5%±6.9%and 36.0%±7.1%respectively(P>0.05);The IFH of semi-rigid internal

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 内固定器 对比研究 

分 类 号：R687.3[医药卫生—骨科学]