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- 2018
动态内固定对单节段腰椎间盘突出症椎间融合的影响
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Abstract:
摘要 目的:比较分析经椎体间融合术合并动态及刚性两种不同内固定方式治疗单节段腰椎间盘突出症(LDH)术后疗效及椎间融合程度的差异.方法:回顾分析51例行后路单节段椎间融合的患者,其中动态组(A组)17例和刚性组(B组)34例,比较两组患者的手术时间、出血量,术前和术后的影像学资料,术后椎间融合程度,以及术前、术后腰部及腿部视觉模拟评分(VAS)、功能障碍评分(ODI)、日本骨科协会评估治疗评分(JOA)等,评估两组的手术疗效,分析比较两种内固定方式术后椎间融合情况及邻近节段退变的差异.结果:51例患者均获得随访,在术后3个月及末次检查发现,腰部及腿部VAS评分、ODI及JOA评分、术椎椎间隙高度差异,两组比较无统计学差异(P >0.05).术后3个月,A组术椎ROM明显高于B组 (P <0.05),而术后末次检查两组术椎椎间活动范围(ROM)(P >0.05)无统计学差异.术后3个月及末次,两组上邻椎椎间隙高度无统计学差异.在术后3个月,两组上邻椎体ROM没有统计学差异(P >0.05),而末次检查A组的上邻椎体ROM低于B组(P <0.05).术后3个月、6个月A组的融合程度评分明显高于B组,而术后末次,两组的融合程度评分(P >0.05)则无统计学差异.结论:动态内固定较刚性内固定有利于节段早期融合及延缓上邻节段退变.
| [1] | RODGERS W B,GERBER E J,PATTERSON J.Intraoperative and early post-operative complications in extreme lateral interbody fusion: an analysis of 600 cases[J].Spine,2011,36(1):26-32. |
| [2] | ZENCICA P,CHALOUPKA R,HLADíKOVá J,et al.Adjacent segment degeneration after lumbosacral fusion in spondylolisthesis:a retrospective radiological and clinical analysis[J].Acta Chir Orthop Traumatol Cech,2010,77(2):124-130. |
| [3] | ANANDJIWALA J, SEO J Y, HA K Y,et al.Adjacent segment degeneration after instrumented posterolateral lumbar fusion:a prospective cohort study with a minimum five-year follow-up[J].Eur Spine J,2011,20(11):1951-1960. |
| [4] | EPSTEIN N E.Adjacent level disease following lumbar spine surgery:A review[J].Surgneurol Int,2015,6(Supple 24):S591-S599. |
| [5] | KREINER D S, SHAFFER W O, BAISDEN J L,et al.An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update)[J].Spine J,2013,13(7):734-743. |
| [6] | INOUE G,MIYAGI M,TAKASO M.Surgical and nonsurgical treatments for lumbar spinal stenosis[J].Eur J Orthop Surg Traumatol,2016,26(7):695-704. |
| [7] | ROHLMAN A,BURRA N K,ZANDER T,et al.Comparison of the effects of bilateral posterior dynamic and rigid fixation devices on the loads in the lumbar spine:a finite element analysis[J].Eur Spine J,2007,16(8):1223-1231. |
| [8] | YAMANISHI Y,YAMAGUCHI S,IMAZATO S,et al.Effects of the implant design on peri-implant bone stress and abutment micromovement:three-dimensional finite element analysis of original computer-aided design models[J].J Periodontol,2014,85(9):333-338. |
| [9] | BETTS D C,MüLLER R.Mechanical regulation of bone regeneration:theories,models,and experiments[J].Front Endocrinol,2014,5:211. |
| [10] | 宋文超, 张思森, 陈勇,等.可控性应力与微动对骨折愈合影响的CT影像结果[J].中华创伤骨科杂志,2015,17(7):624-628. |
| [11] | SONG W C,ZHANG S S,CHEN Y,et al.CT observation of the effect of controlled stress and micromovement on fracture healing[J].Chin J Orthop Trauma,2015,17(7):624-628. |
| [12] | EKMAN P, MOLLER H, SHALABI A,et al.A prospective ran-domised study on the long-term effect of lumbar fusion on adjacent disc degeneration[J]. Eur Spine J, 2009, 18(8):1175-1186 |
| [13] | CHEN B L, WEI F X, UEYAMA K,et al.Adjacent segment degeneration after single-segment PLIF:the risk factor for degeneration and its impact on clinical outcomes[J].Eur Spine J,2011,20(11):1946-1950. |
| [14] | SENGUPTA D K.Dynamic stabilization devices in the treatment of low back pain[J].Neurol India, 2005,53(4):466-474. |
| [15] | LEE S E, JAHNG T A, KIM H J.Facet joint changes after appli-cation of lumbar nonfusion dynamic stabilization[J].NeurosurgFocus,2016,40(1):E6. |
