Topping-off术后上位相邻节段的MRI表现及近期疗效
发布时间：2018-10-20 16:55
【摘要】：[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例仅对L5S1行椎间融合术(融合组);59例采用Topping-off技术,L5、S1椎间融合术同时在L4、5棘突间置入Coflex(Topping-off组)。比较两组术前及随访时VAS、ODI及MRI上L4、5节段椎间盘相对信号强度(relative signal intensity,RSI)变化情况。[结果]融合组与Topping-off组患者临床症状均有显著改善,末次随访时两组的ODI及VAS评分均较术前明显下降,差异均有统计学意义(P0.01),但相同时间点两组间的差异无统计学意义(P0.05)。末次随访时MRI上Topping-off组L4、5节段椎间盘相对信号强度(RSI)显著高于融合组,两组间差异有统计学意义(P0.05)。[结论]腰椎融合术及Topping-off技术对于伴节段不稳或伴有剧烈腰痛的腰椎间盘突出症均有良好且相似的临床疗效,但对于已合并上位邻近节段退变的患者,Topping-off技术缓解患者临床症状的同时更有助于延缓邻近节段椎间盘的退变。
[Abstract]:[objective] to observe the degeneration of interspinous device (Coflex) on MRI, and to evaluate the clinical effect in the near future. [methods] from August 2007 to November 2014, 107 patients with L5/S1 intervertebral disc prolapse combined with L4 or L5 disc degeneration were treated surgically in our hospital and followed up for more than 2 years. Among them, 48 cases were treated with intervertebral fusion only for L5S1 (fusion group), and 59 cases were treated with Topping-off technique. L5S 1 intervertebral fusion was performed simultaneously with Coflex (Topping-off group) in L4 5 spinous process. The changes of relative signal intensity (relative signal intensity,RSI) of L4 segment intervertebral disc on VAS,ODI and MRI were compared between the two groups. [results] the clinical symptoms of both the fusion group and the Topping-off group were significantly improved, and the ODI and VAS scores of the two groups were significantly lower than those of the pre-operation at the last follow-up (P0.01), but there was no significant difference between the two groups at the same time (P0.05). At the last follow-up, the relative signal intensity (RSI) of Topping-off group was significantly higher than that of fusion group on MRI (P0.05). [conclusion] Lumbar fusion and Topping-off techniques have good and similar clinical efficacy in the treatment of lumbar disc herniation with segmental instability or severe low back pain. However, for patients with superior proximal segment degeneration, Topping-off can relieve the clinical symptoms and delay the degeneration of adjacent intervertebral disc at the same time.
【作者单位】： 上海交通大学附属第六人民医院脊柱外科;
【基金】：上海市市级医院新兴前沿技术联合攻关项目(编号:SHDC2014102)
【分类号】：R687.3
[Abstract]:[objective] to observe the degeneration of interspinous device (Coflex) on MRI, and to evaluate the clinical effect in the near future. [methods] from August 2007 to November 2014, 107 patients with L5/S1 intervertebral disc prolapse combined with L4 or L5 disc degeneration were treated surgically in our hospital and followed up for more than 2 years. Among them, 48 cases were treated with intervertebral fusion only for L5S1 (fusion group), and 59 cases were treated with Topping-off technique. L5S 1 intervertebral fusion was performed simultaneously with Coflex (Topping-off group) in L4 5 spinous process. The changes of relative signal intensity (relative signal intensity,RSI) of L4 segment intervertebral disc on VAS,ODI and MRI were compared between the two groups. [results] the clinical symptoms of both the fusion group and the Topping-off group were significantly improved, and the ODI and VAS scores of the two groups were significantly lower than those of the pre-operation at the last follow-up (P0.01), but there was no significant difference between the two groups at the same time (P0.05). At the last follow-up, the relative signal intensity (RSI) of Topping-off group was significantly higher than that of fusion group on MRI (P0.05). [conclusion] Lumbar fusion and Topping-off techniques have good and similar clinical efficacy in the treatment of lumbar disc herniation with segmental instability or severe low back pain. However, for patients with superior proximal segment degeneration, Topping-off can relieve the clinical symptoms and delay the degeneration of adjacent intervertebral disc at the same time.
【作者单位】： 上海交通大学附属第六人民医院脊柱外科;
【基金】：上海市市级医院新兴前沿技术联合攻关项目(编号:SHDC2014102)
【分类号】：R687.3
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