IsobarTTL动态固定系统治疗腰椎退行性疾病的早期临床疗效观察

发布时间：2018-04-19 09:04

本文选题：动态固定 + lsobar　；参考：《北京中医药大学》2015年硕士论文

【摘要】：背景腰椎退行性疾病是造成腰腿痛的常见及主要原因,经保守治疗,疗效不理想的患者,应考虑手术治疗。脊柱融合技术至今,已历经了1个多世纪的发展,经过长期大量的临床研究,证实了其安全性和有效性,被广大的脊柱外科医师认定为治疗脊柱疾病经典的手术方式。但椎间融合固定后改变了脊柱正常的生物力学,脊柱融合后,因为融合节段僵直,脊柱为保持其活动范围,导致邻近节段的活动范围代偿性增加,邻近椎间盘及关节突关节负荷增加,导致邻近节段退行性改变,尤其对于术前就已经存在邻近节段椎间盘脱水、变性者。融合术后,邻近节段退变发病率增高明显。IsobarTTL动态内固定系统理论上具有稳定腰椎,维持椎间隙高度、保留动态固定节段一定的活动度的作用,在一定程度上预防,延缓邻近节段退变的发生。目的1.评价IsobarTTL动态固定系统治疗腰椎退行性疾病的短期临床疗效。2.初步探讨Isobar TTL动态固定系统对邻近节段的保护作用。方法2013年3月至2014年12月东直门医院骨科采用Isobar TTL动态固定系统单节段动态非融合治疗腰椎退行性疾病共30例,术后7d后行腰椎X片复查,患者出院时嘱其门诊定期复查随访,复查腰椎正侧、前屈、后伸位片,测量动态固定节段活动度,椎间隙高度指数,采用UCLA系统评价椎间盘退变情况；记录VAS视觉模拟评分、ODI功能障碍指数,末次随访根据改良的Macnab疗效评定标准评价患者总体疗效。结果30例患者顺利完成手术,随访时间术(6-18个月),平均随访时间10个月,术后各随访时间点VAS评分、ODI评分较术前均明显下降,差异有统计学意义。末次随访时临床疗效评价以改良的MacNab标准,其中优20例,良8例,可2例,差0例,优良率93.33%,末次随访时,所有患者均未发现内固定物移位,断裂等并发症。动态固定节段的ROM随访时均较术前明显下降,差异有统计学意义(p0.01),动态固定节段ISR随访时与术前相比,较术前略下降,与术前相比无统计学意义(p0.05),邻近节段退变无明显进展。结论Isobar TTL动态固定系统治疗腰椎退行性疾病具有较好的近期临床疗效,该动态固定系统在维持了动态固定节段稳定性的同时,能够保留其一定的运动功能,并能于术后良好的维持动态固定节段的椎间隙高度。该动态固定系统对邻近节段的影响较小,在一定程度上可以延缓邻近节段退变。但是本研究随访时间短,样本量偏少。末证明其优点,应与坚强内固定系统对比,需要进一步的随机,对照,前瞻的临床研究。
[Abstract]:Background Lumbar degenerative disease is a common and main cause of low back and leg pain.The spinal fusion technology has been developed for more than a century. It has been proved to be safe and effective by a large number of clinical studies for a long time. It has been recognized by the majority of spinal surgeons as the classic surgical treatment for spinal diseases.But intervertebral fusion and fixation changed the normal biomechanics of the spine. After spinal fusion, because of the rigidity of the fusion segment, the spinal column maintained its range of activities, which resulted in the compensatory increase of the range of activities of the adjacent segments.The load of adjacent intervertebral disc and articular facet joint increased, resulting in degenerative changes of adjacent segment, especially for those with dehydration and degeneration of adjacent intervertebral disc before operation.After fusion, the incidence of degeneration in adjacent segments was significantly increased. Isobar TTL dynamic internal fixation system could stabilize the lumbar vertebrae, maintain the height of intervertebral space, and retain a certain range of motion of the dynamic fixation segment, so as to prevent it to a certain extent.Delay the occurrence of adjacent segment degeneration.Objective 1.To evaluate the short-term clinical effect of IsobarTTL dynamic fixation system in the treatment of lumbar degenerative diseases.The protective effect of Isobar TTL dynamic fixation system on adjacent segments was preliminarily discussed.Methods from March 2013 to December 2014, 30 cases of lumbar degenerative diseases were treated with Isobar TTL dynamic fixation system.The lumbar disc degeneration was evaluated by UCLA system, and the VAS visual analogue score was recorded, and the dysfunction index was recorded, and the dynamic fixed segment motion and intervertebral space height index were measured by reexamination of lumbar vertebrae anterograde, flexion and extension of lumbar vertebrae, and UCLA system was used to evaluate the degenerative status of intervertebral disc.The final follow-up was conducted to evaluate the overall efficacy of the patients according to the modified Macnab criteria.Results the operation was successfully completed in 30 patients, and the average follow-up time was 10 months. The VAS scores at all postoperative follow-up time points were significantly lower than those before operation, and the difference was statistically significant.At the last follow-up, the clinical efficacy was evaluated according to the modified MacNab standard, including excellent 20 cases, good 8 cases, fair 2 cases, poor 0 cases, excellent and good rate 93.33. At the last follow-up, no internal fixation displacement, fracture and other complications were found in all the patients.The ROM of dynamic fixed segment was significantly lower than that of preoperation, and the difference was statistically significant (p 0.01). The ISR of dynamic fixed segment was slightly lower than that of preoperation, and had no significant difference with that of preoperation. There was no significant progress in degeneration of adjacent segment.Conclusion Isobar TTL dynamic fixation system is effective in the treatment of lumbar degenerative diseases in the near future. The dynamic fixation system can maintain the stability of dynamic fixation segment while preserving its motor function.The height of intervertebral space can be maintained well after operation.The dynamic fixed system has little effect on the adjacent segments, which can delay the degeneration of the adjacent segments to some extent.However, the follow-up time of this study is short and the sample size is small.The proven advantages should be compared with a strong internal fixation system, requiring further randomized, controlled, and prospective clinical research.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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