融合联合动态固定治疗多节段腰椎退变性疾病△

Spinal fusion hybridized with dynamic fixation for multi-level lumbar degenerative diseases

摘要:

［目的］ 评价融合联合动态固定治疗多节段腰椎退变性疾病的临床疗效。［方法］ 2017 年 8 月—2019 年 3 月采用融合联合动态固定技术治疗多节段腰椎退变性疾病患者 56 例。观察临床与影像资料。［结果］所有患者手术顺利完成，螺钉置入位置准确，无神经根以及马尾神经医源性损伤。手术节段 L3-5 31 例，其中 26 例融合 L4/5，5 例融合 L3/4；L4~S1 25 例，其中 21 例融合 L4/5，4 例融合 L5S1。随访 （23.23±7.34） 个月，末次随访时腰痛和腿痛 VAS 评分，及 ODI 评分均显著降低 （P<0.05）， 而 JOA 评分显著增加 （P<0.05）。影像方面，与术前相比，末次随访时融合节段的椎间隙高度显著增大 （P<0.05），而节段 ROM 消失；非融合节段椎间隙高度无变化（P>0.05），ROM 显著减小（P<0.05）。所有患者无内置物松动、移位。［结论］融合联合动态固定治疗多节段腰椎退变性疾病临床结果满意。

Abstract:

[Objective] To evaluate the clinical efficacy of spinal fusion hybridized with dynamic fixation for multi-level lumbar degen- erative diseases. [Methods] From August 2017 to March 2019, a total 56 patients underwent spinal fusion hybridized with dynamic fixation for multi-level lumbar degenerative diseases in our department. The clinical and imaging documents were observed and analyzed. [Results] All patients had operation performed successfully with accurate screw placement and no iatrogenic injuries to nerve roots or cauda equina. Of them, 31 patients had lesions from L3 to L5, including 26 patients with L4/5 fusion and 5 patients with L3/4 fusion, while the remaining 25 patients were from L4 to S1, including 21 patients with L4/5 fusion and 4 patients with L5~S1 fusion. At the latest follow-up lasted for (23.23± 7.34) months on an average, the VAS scores for low back pain and leg pain, as well as ODI scores significantly decreased (P＜0.05) , while JOA score significantly increased compared with those preoperatively (P＜0.05) . In term of imaging evaluation, the intervertebral space height in the fused segment significantly increased (P＜0.05) , while the ROM disappeared at the latest follow-up compared with those be- fore operation. By contrast, in the non-fusion segment intervertebral space height remained unchanged (P＞0.05) , with significantly de- creased ROM (P＜0.05) . No loosening and displacement of the implants were noted in anyone of them until the latest follow-up. [Conclusion] The spinal fusion hybridized with dynamic fixation does achieve satisfactory clinical consequences for multi-level lumbar degenera- tive diseases.