腰椎融合辅以邻近节段动态固定治疗腰椎退行性疾病的早期临床疗效观察

目的 评价腰椎融合辅以邻近节段K-Rod动态固定治疗腰椎退行性疾病的临床疗效及对腰椎运动功能的影响,探讨K-Rod动态固定对邻近节段保护的优劣.方法 回顾性分析2010年4月~2011年9月采用椎间融合辅以邻近节段K-Rod 动态固定及单节段椎间植骨融合内固定术的51例患者.A组（K-Rod组）24例患者术前邻近节段存在退变,行单节段融合辅以邻近节段K-Rod动态固定;B组（单节段融合组）27例患者术前邻近节段无不稳或退变,行单节段椎间植骨融合内固定术.对比评价2组腰腿痛视觉模拟量表（visual analogue scale,VAS）评分、Oswestry 功能障碍指数（ Oswestry disability Index,ODI） 、椎间隙高度、腰椎总活动度（range of motion,ROM）及头侧邻近第一节段活动度（ROM1）、头侧邻近第二节段或尾侧第一邻近节段活动度（ROM2）、保护节段及邻近节段退变（adjacent segment degeneration,ASD）发生率.结果随访 24~37个月.2组患者术后VAS评分及ODI均显著改善,且2组间差异无统计学意义.2组间腰椎总ROM术前及末次随访之间均无差异.A组保护节段末次随访时椎间隙高度与术前无差异.2组ROM1及ROM2术前术后相比差异均有显著统计学意义,2组间相比差异无统计学意义.A组末次随访时8例患者出现11（11/138,8%）枚螺钉松动;B组无螺钉松动.结论 腰椎融合辅以邻近节段动态固定具有较好的临床疗效,增加的动态固定保护了术前已存在退变的节段,避免了多节段融合,降低了单节段融合邻椎病的风险,因此适应证选择合适,具有较好的临床应用价值.

Clinical therapeutic effect evaluation of dynamic stabilization adjacent to single-level fusion in lumbar degenerative disease

Objective To evaluate the clinical therapeutic effect of dynamic stabilization adjacent to single-level fusion in lumbar degenerative disease, and the impaction on mobility of segment adjacent to single-level fusion. Methods From April 2010 to October 2011, 51 patients who underwent dynamic stabilization adjacent to single-level fusion or single-level fusion were reviewed retrospectively. In group A(K-Rod group,n=24), adjacent segments of fusion with preoperative degeneration was performed a Topping-off surgery. In group B (Fusion group, n=27), adjacent segments of fusion without preoperative instability or degeneration was performed single-level fusion. The clinical effects were evaluated by visual analogue scale (VAS) scores, the Oswestry disability index (ODI). Lumbar lordosis angle, global lumbar spine range of motion (ROM), ROM of 1st adjacent above segment(ROM1), ROM of 2nd adjacent above segment or 1st adjacent caudal (ROM2), intervertebral space ratio (ISR) of index level (the level dynamically stabilized by Isobar) in group A and adjacent level in group B, the incidence of adjacent segment degeneration (ASD) were compared to evalute the impact to lumbar spine. Results All cases were followed up for 24~37 months, clinical symptoms were significantly improved. VAS score and ODI were significantly improved in 2 groups and no difference between the 2 groups at all follow-up time points. Lumbar lordosis angle and global lumbar spine ROM were no significant difference between 2 groups before operation and at final follow-up. ISR of index level were not significant difference between preoperatively and final follow-up.The ROM1 and ROM2 were not significantly different between Group A and Group B, but were significantly different between preoperatively and final follow-up.Looseness and breakage of fixation system were observed in 8 patients of group A, and none in group B. Conclusion Dynamic stabilization adjacent to single-level fusion achieved satisfactory clinical results in midterm term follow-up. dynamic fixation maybe protect section existing degeneration preoperative, and avoid multisegment fusion,and reduce monosegmental fusion adjacent vertebral disease risk. So it has good clinical value in lumbar degeneration diseases.