Topping-off与融合固定治疗退行性腰椎疾病的临床疗效及邻近节段退变的对比研究

发布时间：2018-06-29 10:51

本文选题：Topping-off + Cofelx　；参考：《中国矫形外科杂志》2017年11期

【摘要】：[目的]探讨Topping-off与融合固定治疗退行性腰椎疾病的临床疗效及对比性研究邻近节段的退变情况。[方法]回顾性研究2010年1月~2013年12月本院收治的99例L3~5退行性腰椎病变患者。根据手术方式不同,分为Topping-off组(L_(4~5)PLIF+L_(3~4)Coflex)45例,男21例,女24例,平均年龄61.50岁(46~77岁);融合固定组(L3~5PLIF)54例,男25例,女29例,平均年龄63.70岁(50~75岁)。记录手术时间、术中出血量及术后并发症。选用Oswestry功能障碍指数(Oswestry disability index,ODI)、视觉模拟评分(visual analogue scale,VAS)评价临床疗效。拍摄腰椎平扫MRI及站立位正侧屈伸位X线片,测量并记录术前、术后2年邻近节段L2-3椎间活动度及椎间盘MRI改良Pfirrmman分级,术前、术后2年Coflex置入节段L_(3~4)的椎间活动度,术后2年Topping-off组复合邻近节段活动度(Coflex置入节段L_(3~4)与其上位节段L_(2~3)椎间活动度之和)。[结果]平均随访时间(35.20±7.80)月(24~48月)。Topping-off组手术时间、出血量明显小于融合固定组(P0.05)。术后2年腰痛及腿痛VAS、ODI评分与术前比较,两组均有明显好转(P0.05)。术后2年L_(2~3)椎间活动度,与术前比较Topping-off组无明显变化(P0.05),融和固定组明显增加(P0.05);组间比较Topping-off组明显小于融合固定组(P0.05)。术后2年Topping-off组复合邻近节段活动度与融合固定组L_(2~3)椎间活动度比较,差异无统计学意义(P0.05)。术后2年腰椎MRI显示L_(2~3)椎间盘改良Pfirrman分级,Topping-off组明显优于融合固定组(P0.05)。[结论]Topping-off对比融合固定治疗退行性腰椎疾病,具有创伤小、出血少、临床效果相似的特点,Coflex置入节段承担近端腰椎部分活动与应力,有助于减缓邻近节段的退变。
[Abstract]:[objective] to investigate the clinical efficacy of Topping-off and fusion fixation in the treatment of degenerative lumbar spine disease and to study the degenerative status of adjacent segments. [methods] A retrospective study of 99 patients with L3 + 5 degenerative lumbar spondylopathy from January 2010 to December 2013 was performed. According to the different operation methods, there were 45 cases of Topping-off group (L _ (4N) PLIF _ (3) Coflex), 21 males and 24 females, with an average age of 61.50 years (4677 years) and 54 cases of fusion fixation group (L3 + 5PLIF), including 25 males and 29 females, with an average age of 63.70 years (50 / 75 years). The operative time, blood loss and postoperative complications were recorded. Oswestry disability index (ODI) and visual analogue score (visual analogue scale VAS) were used to evaluate the clinical efficacy. L2-3 intervertebral motion and modified Pfirrmman grade of intervertebral disc were measured and recorded before operation, 2 years after operation, 2 years before and 2 years after Coflex were implanted into L3 4 segment of lumbar vertebrae before and 2 years after Coflex implantation of intervertebral motion of lumbar vertebrae and lateral flexion and extension of lumbar vertebrae, and the intervertebral motion of adjacent segment L2-3 and modified Pfirrmman grade of disc MRI were measured and recorded before and 2 years after operation. Two years after operation, Topping-off group combined with adjacent segment motion (the sum of Coflex insertion of L3F4 and L2T3). [results] the mean follow-up time was (35.20 卤7.80) months (24-48 months). The blood loss in Topping-off group was significantly lower than that in fusion fixation group (P0.05). Two years after operation, VAS-ODI scores of low back pain and leg pain were significantly improved in both groups compared with those before operation (P0.05). There was no significant change in L2F3 intervertebral activity in the Topping-off group (P0.05), but significantly increased in the fusion fixation group (P0.05), and the comparison between the Topping-off group and the fusion fixation group (P0.05) was less than that in the Topping-off group (P0.05). 2 years after operation, there was no significant difference between the combined adjacent segment motion of Topping-off group and the fusion fixation group (P 0.05). 2 years after operation, the L2T3 modified Pfirrman classification was significantly superior to that of the fusion fixation group in Topping-off group (P0.05). [conclusion] Topping-off fusion fixation for degenerative lumbar degenerative diseases has the characteristics of less trauma, less bleeding and similar clinical effect. Coflex is placed into the segment to undertake some activities and stresses of the proximal lumbar vertebrae, which is helpful to slow down the degeneration of adjacent segments.
【作者单位】：首都医科大学附属北京朝阳医院骨科;
【分类号】：R687.3

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